A Call for More Patients in Health Care

Thursday, February 11, 2016 | Larry Sobal

In the title to this column, you might recognize a homonym. When I refer to “patients,” 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 more than $3 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 likely did nothing to make anyone healthier.

There are lots 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… This is despite that often there is clear clinical evidence that doing “nothing” is the best treatment. Unfortunately, many people don't want to accept that. Isn't an explanation of symptoms—where they come from, when one can expect them to resolve and with what non-invasive/non-prescription solution—in fact, “doing something?”

Too often, the perception of “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 one live better or longer. Perhaps more patients should be asking their physicians these questions:

• Do I really need a certain test or procedure?
• What are the downsides?
• Are there simpler, safer options?
• What happens if I do nothing?
• How much does it cost?

Of course, don't just take my word for it. Go to Google and enter “Low Value Care” and read for yourself about 26 common medical tests and procedures that have no evidence basis for their use with patients in specified circumstances. Or, seek out the information from the Choosing Wisely initiative. Better yet, read the book Less Medicine More Health by H. Gilbert Welch. 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 MRIs 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% 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. And, of course, there are the safety-related issues that comes with tests, procedures and medication.

As the US health care system looks for ways to improve efficiencies and quality while reducing costs, one of the solutions may be amazingly simple: do nothing when nothing is called for!

 

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Larry Sobal is Executive Vice President of Business Development at MedAxiom. He has a 35-year background as a senior executive in medical group leadership, hospital leadership and insurance. As part of his current role, Larry consults, writes and presents on topics relevant to transforming physician practices and health systems.

 

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