Less Care, Better Care?
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?We need to consider…watchful waiting.? |
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We live in a wonderful country. I am proud to live here. Some say we have the best healthcare in the world. I hear that a lot when debates on Obamacare air on talk shows. After all, if you have insurance you can get the best tests right away. Your blood can be analyzed to the smallest enzyme. Your body can be scanned with x-rays, sound waves, in 3D, and with all kinds of nuclear isotopes. Yes, it is a wonderful country.
The problem with all this available care (only for the insured), is that sometimes we ask and receive too much care. There are many studies that show some of these tests we routinely get lead to many false positives requiring more tests and more anxiety for patients. Sometimes these tests require follow up with invasive and risky procedures.
I just finished reading a book called How We Do Harm by a doctor named Otis Brawley. His book is a fascinating look at how doctors over-treat and how this leads to high cost in terms of dollars, pain, and sometimes death. We clearly have an over-treatment problem in America. We consumers many times demand it and doctors in our fee for service model are often happy to meet our demands.
I am guilty of this demand for rapid testing and diagnosis. I used to be a hypochondriac. I do not know why I had health fears but it peaked and ended in my mid-thirties. I suspect it had something to do with fear of leaving my young kids fatherless in a one income household. I imagined I had Lou Gehrig?s disease, rheumatoid arthritis, a weak heart, stomach cancer, and other serious diseases. I had great insurance so my imagined diseases were fully tested. I had numerous CAT scans, MRI?s, nerve conductivity tests, brain scans, EKG?s, and countless blood draws. I was fine but no doctor could convince me. I cost the insurance system many thousands of dollars. For several years I was a mental
mess.
If we want to solve our budget crisis we need to consider the wonderful medical practice of watchful waiting. I do not mean ignoring symptoms or postponing tests. I just mean giving our doctors a little slack in how quickly they send people for tests. Unfortunately, doctors face two issues. First, they fear missing something and getting sued. Second, they want to satisfy their patients so if testing does it they do it. The advocacy groups scream when experts say we have too many mammograms or PSA tests. How dare those evidence based medicine guys recommend against a test!
Regarding prescription drugs, I must admit that some are over-prescribed. Patients want a pill for their complaints and sometimes they get it even though they may not need it or benefit from it. Over time, I expect more comparative effectiveness studies and some drugs will win and some will lose. The future of medicine will be more evidence-based and cost pressures will accelerate that trend. We, as patients, need to demand less, wait a bit longer for the expensive diagnostics, and not get angry with providers if they recommend no interventions, be it drug or surgery.
I?ll end on a personal story. I had my blood PSA (prostate) test recently. My usual normal was about 1.0, but this year it reached 1.6. That is normal but my doctor was concerned about the rise. Therefore I now am getting tested every three months to watch it. There was recently a recommendation not to do PSA testing. The study found it causes many biopsies and surgeries for a cancer that may never migrate outside the prostate. This is a test that once done often causes patients and doctors to demand additional tests and procedures. There are potentially side effects to surgery such as urinary and sexual issues. I am now caught in this testing conundrum. If my PSA goes up again I will be torn with a decision to get a biopsy and then maybe surgery. If I never knew my PSA I might be better off. That is the benefit and curse of our health care system that is limitless for insured patients.
Obamacare is going to cover a lot of prevention testing and we will all be potential beneficiaries and victims of our wonderful diagnostic medicine. That is, until we run out of money and then watchful waiting will rise again as a preferred medical practice.
Bob Ehrlich, Chairman
DTC Perspectives, Inc.
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