Editor's Choice US Editor’s Choice

More healthcare, same outcomes

BMJ 2013; 346 doi: https://doi.org/10.1136/bmj.f1568 (Published 08 March 2013) Cite this as: BMJ 2013;346:f1568
  1. Edward Davies, US news and features editor
  1. edavies{at}bmj.com

Last week the BMJ launched its Too Much Medicine campaign (www.bmj.com/too-much-medicine). The campaign aims to highlight the “threat to human health posed by overdiagnosis and the waste of resources on unnecessary care.”

To illustrate the point, this week’s BMJ podcast includes an interview with Jack Wennberg, emeritus professor of community and family medicine at the Dartmouth Institute, whose recent research paper looked at the bias associated with frequency of visits by physicians in adjusting for illness, using diagnoses recorded in administrative databases (BMJ 2013;346:f549).

If patients living in one area had more diagnoses than those living in another, and used more care, but had similar mortality rates, you might think that they were simply sicker, but that the extra care they were receiving must be good and making them better. Not so, says the research. In the podcast, Wennberg explains how this flawed logic harmfully perpetuates overdiagnosis and variation in care (www.bmj.com/podcast/2013/03/01/compassion-and-variation).

“The intensity with which one encounters physicians creates illness, in a sense,” he tells the BMJ. “The patients who are in these higher intensity regions appear sicker. We have adjustments then made for the payment mechanisms so they get more money. They can then go out and hire more doctors, build more hospital beds, and so this is part of this dynamic which is creating variation.”

The conclusions of the research will make difficult reading for those charged with transforming US healthcare. Not only do they uncover some major inefficiencies inherent in the healthcare system, but the findings also implicate individual medical practice.

Throw in the sequester and ever shrinking budgets, and the challenges become ever more complex. But then, if answers to these dilemmas were easy to come by, somebody would have fixed them already.


Cite this as: BMJ 2013;346:f1568


View Abstract