Too Much Medicine…Have you been on the losing side of it?

What do we mean when we say “too much medicine” and “medicalizing normality”?

• Despite wonderful advances in the assessment and management of musculoskeletal conditions, there have been other less beneficial developments in the care for those with musculoskeletal conditions including the tendency for providing too much medicine.

  • “Too much medicine” includes: overdiagnosis, misdiagnosis, false positives, diagnostic over-medicalization, and over-detection.

    • Okay Courtney… but so what? (Too much medicine has led to overtreatment, overutilization, interventional overmedicalization and low-value care….AKA less than optimal care for you as the patient)

  • “Medicalizing normality” refers to when a normal human function or condition is labeled as abnormal. This creates health concerns where none exist, and healthcare costs when they shouldn’t exist.

Common Examples of too much medicine & medicalizing normality

• Too Much Medicine

  • Nonsurgical Interventions for Pain: Opioid use has been at the forefront of the drive to eliminate pain; the worldwide use of prescription opioids more than doubled between 2001 and 2013 and healthcare providers prescribed them 191 million times in 2017.

  • Orthopedic Surgery: Studies show that many surgical procedures perform no better than sham surgeries (skin incisions and arthroscopy without the actual fix), especially when the patient’s main complaint and reason for seeking surgical intervention is pain. Exercise and physical activity are shown to be consistently as effective as, if not more than, surgery for shoulder pain, knee pain, and the majority of grade 1 through 3 ankle sprains. Why not avoid the increased clinical risk and increased cost of surgery and see a physical therapist first?

• Medicalizing Normality

  • Postural “Abnormalities”: Stating that someone’s symptoms are a result of subtle variations in postural alignment strictly from a quick/static assessment is medicalizing normality. The majority of postural/musculoskeletal presentations are variations of normal and do not differentiate between people with and without pain. There are a few exceptions to this concept including severe kyphosis, scoliosis, and ankylosing spondylitis which may be associated with symptoms.

  • “Abnormalities” detected by imaging: Many diagnostic findings will label normal age-related changes as “abnormalities” that may or may not be associated with the patient’s symptoms. Interventions may then be performed on those patients unnecessarily and likely on tissues that are not actually the cause of symptoms.

    • Examples include:

      • Lumbar disc protrusions, disc bulges, facet joint degeneration, and spondylolisthesis in people without any back pain

      • Labral abnormalities and rotator cuff tendon pathology in baseball pitchers without shoulder pain

      • Osteophytes, cartilage damage, bone marrow lesions, and synovitis in people without knee pain

      • Labral tears in young people without hip pain

What drives too much medicine & medicalizing normality?

• When the more expensive interventions are recommended over lower-cost and more effective alternatives, then profit becomes the driver of the healthcare industry including insurers, pharmaceutical companies, and unfortunately even many clinicians. As consumers, we are convinced that doing something is better than waiting and watching; that the origin of our pain can always be identified with clinical tests and imaging; that our pain can be “fixed” once it is correctly identified; and that not addressing our “abnormalities” puts us at risk for further tissue damage and worsening of the condition.

• SO what can YOU as a patient and consumer do to help make a change?

  • Ask questions about the different treatment and management options for your condition

  • Ask what YOU can do on your own to help manage your condition

  • Ask if “wait and watch” is an appropriate option

  • Share your experiences with the healthcare system to promote improvements in the delivery of healthcare

Take-home Message: Too much medicine can lead to the delivery of healthcare where benefits do not outweigh harms and valuable healthcare costs are wasted.

What is my professional opinion?

Physical Therapists are musculoskeletal experts and are extremely well-equipped to act as the first line of care in the treatment of many musculoskeletal conditions. When you work with us at Plus Forte, we will take a holistic approach to the assessment, treatment, and management of your condition and only refer out as necessary. A thorough examination will allow us to determine if further medical assessment including diagnostic imaging and visits with a medical specialist are necessary or if physical therapy is your best option. This will help save you time, energy, and money in the long run.

Questions? Contact us!

Email: courtney@plusforte.co

Phone: 978-590-6951

Reference:

Lewis, J.S., et al. The Elephant in the Room: Too Much Medicine in Musculoskeletal Practice. J Orthop Sports Phys Ther. Vol. 50, No. 1, 2020, pp. 1-3