US Medical Guidelines May be Biased by Specialty

Treatment guidelines recommended by medical specialist organizations in the United States may be more likely to call for greater use of health care services and exacerbate overdiagnosis, overtreatment, and carry a higher health care cost compared with the United Kingdom, according to a new commentary.

The piece’s author, an assistant professor of management and organizations at Cornell, Sunita Sah, MD, noticed a dramatic difference between guidelines for tests such as mammograms and colon cancer screenings during her time in the United Kingdom and subsequently in the United States.

Her commentary, written alongside Ismail Jatoi of the University of Texas Health, San Antonio, is entitled “Clinical Practice Guidelines and the Overuse of Health Care Services: Need to Reform,” and appeared in the March issue of the Canadian Medical Association Journal.

According to Dr. Sah, guidelines are intended to provide standard evidence-based treatment practices for all physicians. However, guidelines in the United States often demonstrated specialty bias in recommending more aggressive and/or more frequent screening procedures.

“In the US in particular, where the fee-for-service compensation model dominates medicine, which is different from countries like the UK, you see even more recommendations for greater use of health care services," Sah said in a press release.

Specialty bias refers to the tendency of physicians to recommend the treatments for which they are trained to deliver.

"If you go to a surgeon, chances are that they are more likely to recommend that you have surgery; if you go to a radiation oncologist, they are more likely to recommend that you have radiation," Sah said. "They each often believe that the treatment that they're trained in is the better one."

According to the commentary, specialty guidelines are also subject for fee-for-service bias, since doctors who receive a payment for each treatment may tend to recommend it more often. Dr. Sah said that this bias may not necessarily be malicious or intentional. However, it may inhibit a physician from making a decision that best fits the patient’s needs in favor of a habitual understanding of their specialty.

“But more is not necessarily better,” says Dr. Sah. "Sometimes the risks of those procedures are just not worth the benefits."

The authors call for a reduction in conflicts of interest in the fee-for-service model, and more professional diversity in the makeup of the guideline committees.

Reference

• Medical guidelines may be biased, overly aggressive in US [news release]. ScienceDaily website. Published April 5, 2019. https://www.sciencedaily.com/releases/2019/04/190405170450.htm. Accessed April 15, 2019.