Doctors have a hard time backing off on some forms of treatment that are doing more harm than good.
According to Forbes, the too-aggressive treatment of blood pressure in diabetes patients, and of diabetes itself, has led to low blood pressure in the former and low blood sugar levels in the latter.
Doctors are having a difficult time in reducing the level of treatment in patients who experience negative side effects, even when those negative side effects can outweigh the other benefits of continuing the treatment causing them. A study in JAMA Internal Medicine found that doctors weren’t backing off on hypertension treatments even when they caused a drop in blood pressure below recognized levels. There was also a lack of reduction in diabetes medications when patients’ blood sugar levels — their A1C results — fell too far.
Researchers found that, when patients’ blood pressure levels fell below 120/65, less than a quarter of the doctors studied reduced the dosage of patients’ blood pressure pills — even for patients who were so old or ill that they probably had fewer than five years to live.
The researchers were concerned about the age and health of the patients being treated, since the benefits of aggressive treatment accrue over many years, compared with the benefits of more moderate treatment, particularly when the side effects induced by such aggressive treatment show up quickly.
For patients judged to have five years or less to live, based on age and other factors, doctors still didn’t back off from aggressive treatment regimens despite the real harm some of those regimens induced in their patients — such as an increased risk of hazardous falls from low blood pressure.
The doctors treating diabetes patients with low blood sugar levels did marginally better on backing off when the patients were actually suffering from aggressive treatment; they reduced treatment just a third of the time when patients’ A1C levels were lower than 6, even if those patients were expected to live fewer than five years more.
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