A BBC report from earlier this weeks makes it very clear: overuse of elective medical procedures is not just an American problem, or even just a developed-world problem. The report tells the story of women in a number of rural villages in India, where hundreds of women have been convinced, cajoled, and frightened into having hysterectomies they almost certainly didn't need.
The story suggests that the procedures are probably being done to make money for unscrupulous local doctors. The docs work in India's private medical system, but the public insurance program for the poor allows patients to see private physicians when they can't acces the public healthcare system. According to the story, the doctors often tell patients they have cancer and need an immediate hysterectomy--sometimes without even performing a biopsy, and without offering other, less invasive forms of cancer treatment. Unnecessary operations make money for the physician, but they're a huge financial burden for patients--and although the article didn't mention it, unnecessary treatments also expose patientsto needless risk of serious complications and death.
The Indian government is starting to react to the apparent epidemic of overuse. But in addition to fixing perverse financial incentives, it's important to consider the role informed and empowered patients can play in ensuring unnecessary treatments don't happen. The article notes that women find it hard to refuse a surgery that the doctor says they need right away. One young woman said she wasn't even able to discuss the surgery with her husband first. Fixing that rushed and insensitive process is crucial. Patients in rural India have just as much right to make their own decisions as patients in rural Indiana--and fortunately, there are effective tools to help them make those decisions. Even if the public medical system can't yet reach all parts of rural India, it might be possible for the government to make sure shared decision making and decision aids are available--that could save money, and help patients avoid unnecessary treatment.
UPDATE: Dr. Mohammad Zakaria Pezeshki, Associate Professor in the Department of Community Medicine at Tabriz Medical School in Tabriz, Iran, saw this post & responded with some good thoughts of his own. He points out that it's crucial to have decision aids in patient-accessible languages, and that opportunities to inform and engage patients are not limited to shared decision making. Check out the post and the rest of his blog, Earth Citizens' Health!