Quality Talks With Peggy O'Kane: The Hidden Harms of 'Doing More': A Cardiologist's Perspective

Quality Matters: A Podcast by NCQA

In this episode of Quality Talks With Peggy O’Kane, NCQA President Peggy O'Kane sits down with Dr. Rita Redberg, a cardiology pioneer and fierce advocate for evidence-based care. Dr. Redberg, who famously served as Editor-in-Chief of JAMA Internal Medicine for 14 years, shares her "Less is More" philosophy — a perspective that challenges the view that "more" care is always better.

Join Peggy and Rita as they explore:

• The Problem with "More": Why a health care culture focused on technology and volume over patient needs leads to runaway costs and poor results.
• The Stent Story: How a widely adopted procedure in cardiology gained traction without initial evidence of patient benefit, and the uphill battle to integrate rigorous clinical trials.
• Mary Caldwell's Odyssey: A cautionary tale illustrating the dangerous cascade of unnecessary testing and interventions, based on a desire for reassurance rather than clinical need.
• Re-evaluating Statins: Rita’s unconventional view on the use of statins in asymptomatic people. She advocates lifestyle changes over medication when the evidence of benefit is thin.
• Rebuilding Trust: How the fee-for-service payment model erodes the patient-doctor relationship and how regulatory reforms can shift incentives towards patient wellbeing.

Rita reminds us that health care quality isn't about more tests or interventions. It’s about thoughtful, patient-centered decisions and a commitment to "first, do no harm." This episode is a must-listen for anyone curious about improving health outcomes and reducing waste in health care.

Key Quote:

Most statins are prescribed for people that have not already had a heart attack or have established coronary disease. In that higher risk group, there is some benefit to taking statins. It's not huge but there is some benefit.

But most people I see, and most people taking statins, are not in that category. They're healthy people that want to prevent a heart attack and want to live longer. They definitely are not going to feel better.

Rita Redberg, MD

Time Stamps:

• (02:09) Misconceptions in Medicine
• (10:01) Mary Caldwell: A Cautionary Tale
• (13:35) Choosing Wisely Campaign: A Step Towards Better Care
• (16:32) Debating the Use of Statins
• (21:31) Trust, Incentives and the High Cost of US Care
• (27:05) Technology, Teams and Trust

Links:

JAMA Internal Medicine “Less is More”

Choosing Wisely

Connect with Rita