Do no harm: Pediatrician calls for safely cutting back on tests, treatments
When parents take a sick or injured child to the doctor or emergency room, they often expect tests to be done and treatments given. So if the physician sends them on their way with the reassurance that their child will get better in a few days, they might ask: "Shouldn't you do a CT scan?" or "Can you prescribe an antibiotic?"
What families—and even doctors—may not understand is that many medical interventions done "just to be safe" not only are unnecessary and costly but they also can harm patients, said Alan R. Schroeder, MD, FAAP, who will present a plenary session at the American Academy of Pediatrics (AAP) National Conference & Exhibition. Titled "Safely Doing Less: A Solution to the Epidemic of Overuse in Healthcare," the session will be held from 11:30-11:50 a.m. PDT Monday, Oct. 13 in Ballroom 20 of the San Diego Convention Center.
Dr. Schroeder, chief of pediatric inpatient services and medical director of the pediatric intensive care unit at Santa Clara Valley Medical Center in San Jose, Calif., will discuss some of the reasons why doctors provide unnecessary care (i.e., barriers to safely doing less), including pressure from parents and a fear of missing something.
"We all have cases where we're haunted by something bad happening to a patient. Those tend to be cases where we missed something," he said. "We tend to react by doing more and overtreating similar patients."
He also will give examples of where overuse commonly occurs in pediatrics, such as performing a CT scan on a child with a minor head injury, and the negative consequences.
"You may find a tiny bleed or a tiny skull fracture, and once you've found that you're compelled to act on it. And generally acting on it means at a minimum admitting the child to an intensive care unit for observation even if the child looks perfectly fine," Dr. Schroeder said. "The term for that is overdiagnosis. You detect an abnormality that will never cause harm."
Finally, he will suggest ways to minimize overtesting and overtreatment, highlighting the Choosing Wisely campaign. More than 60 medical societies including the AAP have joined the initiative and have identified more than 250 tests and procedures that are considered overused or inappropriate in their fields.
"I've devoted much of my research to identify areas in inpatient pediatrics where we can safely do less—which therapies that we are doing now are unnecessary or overkill," Dr. Schroeder said.