Fixing Problems Is Not Always Best
Fixing Problems Is Not Always Best
April 1, 2025
Joy Stepinski, MSN, RN-BC
An important piece of making health decisions is avoiding too much medical care. In the book Less Medicine More Health: 7 Assumptions that Drive Too Much Health Care [1], Dr. Gilbert Welch presents seven assumptions that drive not only healthcare, but also public policy. We will consider these assumptions and how this knowledge can avert overdiagnosis and provide meaningful care.
The second assumption is that fixing the problem is always the best choice. In one example, Welch discusses a randomized trial on angina patients called COURAGE. One group was comprised of patients with stable angina, which means that their chest pain occurred with activity and was relieved by rest. The second group was diagnosed with a narrowed coronary artery by at least 70%. Patients who underwent a balloon angioplasty to fix the obstruction were compared with those who were treated with medication.
The results showed that patients who underwent the angioplasty, an invasive procedure, were not less likely to die or experience a heart attack than those who received medication. In one follow-up study, the authors relate, “A key point to emphasize is that atherosclerosis is a systemic, generalized vascular disorder, and not merely a focal disease that can be managed optimally by treating only stenotic coronary segments” [2].
How can you apply this to making a health decision? Be aware that some treatments may resolve a specific condition, but some may not help or could even worsen health problems. Welch suggests starting slow with the most conservative option first [2]. If you decide to undergo a major elective procedure, obtain more than one opinion. An unbiased provider, not performing the procedure, could review the benefits and drawbacks with you using high-quality research. Finally, determine your end goal and the importance of the treatment you seek. Is it to live longer or feel better? “If you feel good now, you have every reason to demand high-quality evidence from a randomized trial that fixing your ‘problem’ will help you live longer” (p. 50).
References:
Welch, H. G. (2015). Less medicine, more health: 7 assumptions that drive too much medical care. Beacon Press.
Weintraub, W. S., Mancini, G. J., & Boden, W. E. (2023). Percutaneous coronary intervention from COURAGE to ISCHEMIA and beyond. International Journal of Cardiology, 373, 39-43. https://doi.org/10.1016/j.ijcard.2022.11.034