RESUMO
Overtreatment refers to interventions that do not benefit the patient, or where the risk of harm from the intervention is likely to outweigh any benefit the patient will receive. It can account for up to 30% of health care costs, and is increasingly recognised as a widespread problem across nations and within clinical and scientific communities. There are a number of inter-related factors that drive overtreatment including the expanding definition of diseases, advertising and the influence of the pharmaceutical industry, how doctors are trained and remunerated, demands from patients (and their families) and the fear of complaints leading doctors to practise defensively. This paper discusses a number of ethical and practical issues arising from overtreatment that doctors and patients should be aware of. It also considers the flow-on effects of overtreatment such as the increased cost of care, increase in work load for health professionals, and wastage as resources are diverted from more genuine and pressing needs. In addition, there are references to a number of Medical Council of New Zealand statements about what good medical practice means in an environment of resource limitation. The paper concludes with a few measures that doctors and patients could take to reduce overtreatment but acknowledges that health care is extremely complex so it would be unrealistic to eliminate overtreatment entirely.
RESUMO
Having a doctor in the family is often seen as beneficial as there is easy access to medical advice and care. It is common for doctors to treat themselves and those they are close to, and some doctors consider this their prerogative. However, there are pitfalls. Primarily, there is a risk of compromising clinical judgement and objectivity when doctors self-treat and treat those they have a close relationship with. This could lead to treating problems beyond the doctor's competence-in some instances, because someone close pressures the doctor. Other pitfalls include trivialising or overtreating a condition, failing to document the care provided, making assumptions about a person's circumstances, and breaching confidentiality. Consequently, despite good intentions, a doctor may not provide the best quality care to those they are close to. This paper examines the ethical and practical issues that arise when doctors treat themselves and those they have a close relationship with. It argues that in the vast majority of clinical situations, doctors should not engage in such care arrangements, and explains why doctors should have their own regular doctor. Several cases where doctors in New Zealand have been censured for self-treatment will be discussed. The paper compares New Zealand's position with Singapore's and explores several factors that contributed to the different positions that were adopted. The paper concludes that this is a fraught area of care so it is important that medical regulators set standards that promote best practice and that provide clear guidance to the profession and public.
