Saturday, June 04, 2016

'Illusion of control' leads to inappropriate medical treatment use

Public Release: 30-Mar-2016
'Illusion of control' leads to inappropriate medical treatment use
NEJM Perspective calls for research into the relationship between illusion and misuse of treatment
University of Pennsylvania School of Medicine

The U.S. presidential campaign season has reignited debates on how best to deliver cost-effective, high quality care. A new perspective paper in the New England Journal of Medicine advocates for a comprehensive approach to recognize and manage "therapeutic illusion" to improve use of medical treatments. The therapeutic illusion--an unjustified belief in treatment--has been proven in previous studies in different environments. Consistently, physicians have reported overestimating the benefits of inappropriate tests and treatments.

"Physicians' belief that their actions or tools are more effective than they actually are can perpetuate unnecessary and costly care," writes David J. Casarett, MD, MA, a professor of Medicine at the Perelman School of Medicine at the University of Pennsylvania and director of Hospice and Palliative Care at Penn Medicine, and author of the paper. "Efforts to promote more rational decision making will need to address this illusion directly."


Methods of managing therapeutic illusion should be approached with caution, as "reimbursement pressures, quality measures, fear of litigation, and family expectations" among other factors, can all drive overtreatment. Targeting ineffective treatment associated with therapeutic illusion, without questioning the effectiveness of that strategy, "falls prey to therapeutic illusion itself," the author notes. Research into whether and how managing therapeutic illusion can decrease overtreatment, how therapeutic illusion might actually improve care, and how best to include those results in medical education, is critical.


"All physicians can begin to address therapeutic illusion immediately," Casarett said. "By evaluating their own practice, examining their own beliefs, and applying simple conscious heuristics, all physicians can contribute to more rational, evidence-based care."

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