In the title to this column, you might recognize a homonym. When I refer to "patient," I am really asking for more "patience" to be practiced in health care. Let me explain.
Health care in America has experienced an explosion in knowledge, innovation, and capacity to manage previously fatal conditions. Yet, ironically, it often falls short on such fundamentals as quality, outcomes, cost, and equity. I think part of our problem is that we are too often fixated on doing "something" when attentive patience is more appropriate.
Consider this, America spent $2.6 trillion on health care last year; about one in every six dollars went into the health care system. Some experts suggest that a third of that spending - a full $750 billion - likely did nothing to make anyone healthier.
There are lot's of reasons of course, but here's a common frustration I hear from physicians. When a patient comes to see them, there is usually an expectation "something" will be done: a test ordered, a procedure scheduled, a prescription written, etc. ? Often there is clear clinical evidence that doing "nothing" is the best treatment. Unfortunately, people simply won't accept that.
Too often, good health care means seeing as many specialists as possible. undergoing rounds of tests and prolonged hospital stays and extensive treatment. Though the idea that more health care is better might seem logical, research shows that in many instances none of the above necessarily helps you live better or longer.
Don't take my word for it. Go to Google and check out the project called Choosing Wisely. Or, seek out the June Consumer Reports. Better yet, read the book "How We Do Harm" by Dr. Otis Brawley. We are finally waking up to the fact that indiscriminate treatment without a thought to how much it costs-in comparison to how much it will help-is breaking the bank and potentially causing harm.
I'm not just talking about prescribing antibiotics for a child's sore throat caused by a virus when it will have no impact ($166 million annual costs). This problem runs the gamut, such as ordering unnecessary CT Scans or MRI's for lower back pain ($175.4 million) to probably the most taboo subject of all - end-of-life care.
It's a touchy subject, but the reality is that one out of every four Medicare dollars, more than $125 billion, is spent on services for the 5 percent of beneficiaries in their last year of life. When patients have a terminal illness, at some point more disease treatment does not equal better care.
Lest you accuse me of rationing, there are legitimate safety-related issues at stake. All medical tests carry some risk. The radiation you are dosed with from an X-ray or CT scan better be for a good reason. Then there's the risk of an invasive test causing an infection, or a useless prescription causing a side effect.
An explanation of symptoms - where they come from, when you can expect them to resolve and with what non-invasive/nonprescription solution-is, in fact, "doing something." When you see your physician, consider asking the following questions:
? Do I really need this test or procedure?
? What are the downsides?
? Are there simpler, safer options?
? What happens if I do nothing?
? How much does it cost?
The U.S. health care system needs lots of improvement. Left unchanged, health care will continue to underperform; cause unnecessary harm; and strain national, state, and family budgets. Ironically, one of the solutions may be amazingly simple - do nothing when nothing is called for.
- Larry Sobal is system vice president of cardiovascular services at ThedaCare. He can be reached at 920-731-8900 or at firstname.lastname@example.org.