Less Medicine, More Health: 7 Assumptions That Drive Too Much Medical Care by H. Gilbert Welch

When it comes to the consequences of over-medicalization, leading physician, professor, and author Dr. H. Gilbert Welch has a lot to say. In his book Less Medicine, More Health, Dr. Welch challenges the idea that more medical care equals more health.

Dr. Welch argues that the assumptions our current medical system is built on — that medical care is good, that more is better, and that there’s a medical solution to every medical problem — create a system that over medicalizes, leading to more harm than good. The assumption of more is better, he says, ignores the fact that medical care may cause undesired outcomes and harms, and that sometimes more care can result in worse outcomes – more distress, more disability, and even more suffering for patients.

Dr. Welch outlines seven system-creating assumptions he believes are driving too much medical care:

1. All Risk is Bad: All risk is seen as bad, from even the smallest risk of poor outcomes. This view of risk leads to unnecessary tests and treatments, with little attention paid to benefits of the intervention or alternatives.

2. There Are Always More Interventions: There are an infinite number of interventions available for any given condition, but this gives a false impression that these interventions are all helpful or necessary. The focus should be on whether the intervention helps or harms the patient, and not just on that there’s something available to try.

3. Undetected Disease is the Enemy: There is an assumption that medical care is helpful when it identifies and treats undetected disease. However, in most cases, there is a benefit to not knowing, either because the risk of the condition is very small, or because the available treatments do not alter the course of the disease.

4. Covering All Possibilities is Good: Doctors and patients both assume that by testing for all possible conditions, they are providing the best care. Unfortunately, tests raise the possibility of false positives and unnecessary treatment.

5. Everyone Should Be Treated the Same: Dr. Welch suggests that instead of treating everyone the same, physicians should tailor care to each patient, based on their individual circumstances, values, and preferences.

6. More Information is Better: It is assumed that more information is always better. While this is generally the case, in some circumstances, the information can raise the possibility of false positives and unnecessary treatments.

7. There Is No Place for Uncertainty: Physicians and patients alike often cling to the false idea that there is no place for uncertainty in medicine, and instead that medical problems should be able to be solved with certainty. However, Dr. Welch argues that medical care requires uncertainty, and that understanding and managing that uncertainty is an essential part of providing quality patient care.

Dr. Welch's book Less Medicine, More Health takes a hard, critical look at our current medical system and the assumptions that drive too much medical care. By recognizing and challenging these assumptions, Dr. Welch argues, we can create a healthier medical system that doesn’t just prolong lives but improve them.