Bioethics Blogs

Old Practices Die Hard

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Below is a recent article written by Niam Yaraghi of U.S. News and World Report on why doctors continue to perform expensive and unnecessary tests like prostate cancer screening.

Unnecessary and harmful medical procures are a major source of waste in the U.S. health care system. Prostate-specific antigen-based screening (or PSA-based screening) for prostate cancer is an example of such procedures. According to the independent U.S. Preventive Services Task Force, “there is moderate certainty that the benefits of this procedure do not outweigh the harms.” Despite the task force’s discouragements, we spent $132.6 million to perform PSA-based prostate cancer screening on patients covered by Medicare in 2012.

If physicians are recommended not to perform this test, then why do they continue to do so? One can think of two obvious reasons. First, the scientific evidence on the benefits and harms of such tests is not yet exactly clear and thus clinicians have to rely on their own medical hunch rather than solid and irrefutable medical guidelines to make decisions. The second is the usual suspect: Physicians make money from doing these unnecessary tests. As long as physicians are compensated for volume rather than the value of their services, they will be financially inclined to perform as many tests as they can.

In a recent paper, Peter Ubel and David Asch offered additional psychological explanations for why it is difficult for clinicians to “‘de-innovate,’ or give up old practices, even when new evidence reveals that those practices offer little value.” They argued that physicians’ preconceptions lead them to scrutinize the studies that provide evidence against their initial beliefs and instead have a bias toward the studies that confirm their stand.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.