Hospitalists Can Bring Attention to Overuse of Medical Services

A major review of the medical literature from 1978 to 2009 on the overuse of health services found the topic understudied, with limited data except in a few areas, such as antibiotic use for upper respiratory infections.

Overuse of medical services—services with no benefit or for which harm outweighs the benefit—needs more attention and more investment, says Deborah Korenstein, MD, of Mount Sinai School of Medicine in New York, the review’s lead author. Until that happens, she says, it will be premature for health policy makers to talk about cost savings to be accrued under healthcare reform from reductions in overuse and waste.

Dr. Korenstein sees opportunities for hospitalists to initiate studies of health resource usage, costs, and opportunities for improving efficiency, making these part of their hospitals’ quality initiatives.

"People in healthcare have talked about overuse without understanding what it means, how common it is, and how intractable it can be to remedy," she says, adding it’s a difficult subject to study, without recognized standards for measuring overuse. "Some situations are clearly inappropriate—for example, antibiotics for colds. That doesn’t mean they’re easy to get rid of."

The main finding: there is very little evidence on overuse, Dr. Korenstein says. For people on the front lines of healthcare, she recommends mindfulness to the issue.

"Challenge yourself to think about what you’re doing and why," she says. "Resist doing interventions just because you can."

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