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Special Communication | Less Is More

Update on Medical Overuse

Daniel J. Morgan, MD, MS1,2; Scott M. Wright, MD3; Sanket Dhruva, MD4
[+] Author Affiliations
1Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
2Department of Hospital Epidemiology, Veterans Affairs Maryland Health Care System, Baltimore
3Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
4Department of Internal Medicine, University of California Davis Medical Center, Sacramento
JAMA Intern Med. 2015;175(1):120-124. doi:10.1001/jamainternmed.2014.5444.
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Importance  Overuse of medical care, consisting primarily of overdiagnosis and overtreatment, is a common clinical problem.

Objective  To identify and highlight the most significant clinical articles published in 2013 related to medical overuse.

Evidence Review  A systematic review of English-language articles published in 2013 that related to medical overuse in adults.

Findings  We reviewed 478 published articles that met our inclusion criteria. Of these, 126 were ranked most relevant based on quality of methodology, strength of results, potential effects on patient care, and the number of patients potentially affected. The 10 most relevant articles were selected using the same criteria. These 10 articles (organized into the categories overdiagnosis, overtreatment, and methods to avoid overuse) were reviewed and interpreted for their effect on clinical medicine.

Conclusions and Relevance  The literature on overuse of medical care is rapidly expanding. In 2013, both clinical trials and observational studies highlighted frequently overused or unnecessary care. Overuse of testing causes false-positive results and overdiagnosis. Negative test results do not appear to genuinely reassure patients. Overtreatment, with both medical therapies and procedural interventions, places patients at risk of unnecessary adverse events.

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Articles Identified by Systematic Review Chosen for 10 Clinically Important Manuscripts or 25 Honorable Mention Manuscripts

Process used by authors to identify 10 most relevant articles.

aLancet, BMJ, JAMA, JAMA Internal Medicine (formerly Archives of Internal Medicine), New England Journal of Medicine, Annals of Internal Medicine, Medical Care.

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