Doctors prone to misjudge harms, benefits

It may not surprise that patients are overly optimistic about medical interventions, but doctors are doing it too

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Health practitioners struggle to accurately gauge risks in medicine, tending to overlook harms and inflate benefits, a study shows.

A review of 48 studies found that GPs, specialists and healthcare professionals failed to correctly estimate harms of treatments, screening and tests in 87% of cases.

The 13,000 clinicians involved in the study “rarely had accurate expectations of the benefits and harms”, said the authors from Bond University. “Inaccuracies are likely an important contributor to the massive overuse of tests and treatments.”

The researchers found that clinicians were only able to correctly estimate benefits in one in every 10 cases.

Health practitioners tended to overrate benefits in around one-third of instances and study participants more frequently underestimated than overestimated harms (34% vs 5%).

Dr Justin Coleman, a Brisbane GP, told The Medical Republic the review mirrored studies that showed patients were overly optimistic about medical interventions.

“But it is fascinating to see that we doctors are, as well,” he said.

While this research might make some doctors uncomfortable, “honest, continual self-reflection is a key to maturing as a profession.”

The review examined studies from 17 countries, including three from Australia, and covered a range of interventions, such as cancer screening, fetal and maternal medicine, cardiovascular disease prevention, surgery and medication.

The study follows the release of a series in The Lancet this week showing that both the overuse and underuse of medicine is increasing around the globe.

Among other examples, researchers identified that 20% of knee replacements after an arthroscopy in Australia were unnecessary, “low-value” services.

Dr Paul Glasziou, co-author of the series and Professor of Evidence-Based Medicine at Bond University, said unrealistic expectations were among several important drivers of overuse in Australia.

Other factors leading to unnecessary treatment included greed, competing interests, poor information, financial incentives, and cultural influences.

“Solutions are needed at multiple levels to address the problems,” Dr Glasziou said. “Decision aids will be one element of that.”

Currently, information about harms and benefits was “scattered across hundreds of journals” and there were few decision support tools available, the authors explained.

“To facilitate discussions, clinicians need ready access to up-to-date, concise, and clear summaries.”

JAMA Internal Medicine 2017, online January 9