Covid-19 is opening the door for researchers to address a problem that has vexed the medical community for decades: the overtreatment and unnecessary treatment of patients.
On one hand, the pandemic caused major health setbacks for non-covid patients who were forced to, or chose to, avoid tests and treatments for various illnesses. On the other hand, in cases in which no harm was done by delays or cancellations, medical experts can now reevaluate whether those procedures are truly necessary.
Numerous studies have shown that overtreatment causes unnecessary suffering and billions of dollars in unnecessary health care costs.
But never before, said researcher Allison Oakes, has there been such a large database to compare patients who received a particular test or treatment with those who did not.
Oakes was a principal author of an October in Health Affairs by the Research Consortium for Health Care Value Assessment. The paper noted that covid provided an important new measurement 鈥 examining outcomes for patients who received treatment before hospitals canceled care because of covid and those who had their care canceled.
Areas ripe for study, said Oakes: colonoscopies done on patients older than age 85; hemoglobin blood work for Type 2 diabetes patients; semi-elective surgeries, such as knee arthroscopy for articular cartilage surgery; and yearly dental X-rays. All were done less often because of covid, she said.
鈥淭here are two sides of the pie: low-value care and care that people get in trouble if they don鈥檛 get,鈥 said Oakes, who expects researchers to take advantage of all the data provided from covid on 鈥渂oth types of care.鈥
One recent looked at Veterans Affairs patients who had elective surgeries canceled because of covid. The study found they were no more likely to visit hospital emergency departments than patients who had undergone those surgeries in 2018.
of Brigham and Women鈥檚 Hospital and Harvard Medical School said much testing and care was cut back by patients鈥 fears of contracting covid in a medical setting and because medical facilities and staffers were fighting just to keep up with covid cases.
鈥淭here are some procedures, tests, and exams that cannot be delayed in any situation,鈥 Lyu said in an email. For example, she pointed to the screening, surveillance and treatment of cancer patients.
However, she said other tests and treatments can be delayed or canceled without negative effects. Lyu oversaw a of 2,000 physicians, with half the doctors saying the percentage of unnecessary medical care was higher than 20.6% and half saying it was lower.
Unnecessary treatment or overtreatment can result from several factors, the doctors in Lyu鈥檚 survey said. Concerns about malpractice lead doctors to test even for unlikely problems to avoid missing something, they said. Sometimes health providers have difficulty assessing patients鈥 prior medical records. Then there is the incentive for the health industry to boost revenue, sometimes to help pay for expensive testing equipment, the doctors said.
Leaps in technology are a major factor.
, a radiologist at Johns Hopkins Medicine in Baltimore, said a CT scan that provided 30 or 40 images when she began practicing in the 1990s now provides thousands of high-resolution images.
鈥淲e now see things that we would have never seen before, like a lesion that may never become a problem,鈥 Wruble said.
Wruble said some patients still opt for aggressive medical treatment for things like that questionable lesion.
鈥淧atients 鈥 often resist advice to 鈥榳atch and wait鈥 and will demand surgery even when the operation itself comes with potentially dire consequences,鈥 Wruble said. The consequences are not only higher costs but potentially years of physical discomfort and pain, along with diminished physical abilities, she said.
, dean and professor at the William F. Connell School of Nursing at Boston College, said covid provides not only opportunities to study unnecessary medical care, but also opportunities to examine areas of insufficient care. She cites a lack of mental health resources for covid patients suffering through difficult treatment and even facing death without friends or family.
鈥淲hen we are thinking of new ways to treat, we all need to think about our fascination with surgery and invasive procedures and start thinking more holistically about health,鈥 Gennaro said.
Covid鈥檚 upending of scheduled non-covid care hit hard in March and April last year, when the pandemic first began to overwhelm hospitals. Cancer surgery scheduled in April for Krista Petruzziello, for example, was postponed due to the focus on covid care.
Instead of surgery, the 49-year-old real estate agent from Lowell, Massachusetts, received hormonal treatment usually reserved for breast cancer patients with larger tumors.
鈥淚t was concerning for sure,鈥 said Petruzziello. 鈥淲ho knew a year ago how long it would be until surgery would be available for patients like me?鈥
It was only about six or seven weeks later when she had successful surgery to remove a tumor shrunken by the hormonal treatment. A recent follow-up scan found her clear of cancer, she said.
鈥淢aybe there will be cases where the tumor disappears altogether [from hormonal treatment], allowing the surgery to be canceled,鈥 Petruzziello said. 鈥淲ouldn鈥檛 that be a good thing?鈥
, an oncologist at Dana-Farber Cancer Institute in Boston who treated Petruzziello, said breast cancer surgery will remain a key component of treatment for the foreseeable future. But he said hormone treatment 鈥渂efore surgery鈥 can shrink the tumor and 鈥渉opefully make for less extensive surgery.鈥
Covid, he said, forced health care providers to 鈥渢hink outside the box.鈥