"When Costly Medical Care Just Adds to the Pain"


New York Times article

"A growing body of research indicates that about 30 percent of what is now spent on medical tests and procedures is wasteful, unlikely to benefit anyone except those whose pockets are lined as a result. Unless this waste is curbed, rationing will almost certainly become a reality in the not-too-distant future.

Patients don’t want to be denied a test or treatment that they or their doctors believe could improve their health or save their lives — no matter what the cost. But simple faith in a procedure’s effectiveness is not enough.

Each medical decision should be based on the best available evidence, combined with the doctor’s best clinical judgment about what is right for each patient. Only then can we put an end to the current practice of doing whatever is possible, no matter what the odds of success. But too often, patients and their advocates insist on procedures that have little or no chance of success, including some very costly treatments not yet proved — or even disproved — to be beneficial in well-designed clinical trials. A case in point was noted recently by Dr. Howard Brody (no relation) of the University of Texas Medical Branch in Galveston: the treatment of advanced metastatic breast cancer with high-dose chemotherapy, followed by bone marrow transplantation.

Initially, it was thought that the procedure had perhaps a 10 percent chance of significantly extending a patient’s life. But “the actual chance of meaningful benefit from this treatment is zero, and that the only effect of the treatment was to make patients’ remaining months of life miserable,” Dr. Brody wrote recently in an article in The New England Journal of Medicine titled “From an Ethics of Rationing to an Ethics of Waste Avoidance.”

By reducing wasteful, unproductive tests and procedures, experts say, it should be possible to preserve Medicare and Medicaid without wrecking Social Security and federal and state budgets, and without depriving providers of reasonable remuneration for their services.

At long last the medical profession itself has decided to try to relegate wasteful procedures to relative obscurity, with only occasional, justifiable exceptions.

Spurred by the American Board of Internal Medicine Foundation, 17 medical specialty societies have been enlisted to discourage overuse of rarely productive tests and treatments. Nine of those societies have already weighed in, each with five practices that their elite members agreed were only sometimes helpful under special circumstances. Together, unnecessary procedures like these currently waste an estimated $700 billion a year.

By establishing these recommendations as standards of care, the societies reduce the risk that doing less may spur malpractice suits, which currently prompt many doctors to overtest and overtreat — so-called defensive medicine….

…Of course, doctors are not the only ones who have to change. Patients, too, must accept the fact the more can be less and not demand procedures that are no longer recommended or shop around for doctors who will meet their ill-advised demands.”

I think a lot of this reform is going to require some cultural rewiring of American patients’ attitudes about healthcare.

(via russalex)

Cardiologist Speaks From The Heart About America's Medical System


There’s no question that there’s a lot of unnecessary testing in American medicine today and the reasons for it are manyfold. Part of it is … a lack of time. You have a patient come into your office and you have eight minutes with them and they have lower back pain and you don’t want to miss something because one of the major causes of dissatisfaction among doctors today is malpractice liability; there’s that fear.

A lot of doctors are practicing defensive medicine. There have been various estimates that defensive medicine costs up to $100 billion a year out of the roughly $3 trillion we spend on health care, so it’s a huge, huge waste. … It takes time to evaluate the patient, get a good history, examine the patient, and it’s just so much easier to order a test— especially when the financial incentives of the system are to reward for more and more testing.” 

(via russalex)


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