Rosie
Recycles dryer sheets
An excellent article in the May 11 issue of the New Yorker:
America's Epidemic of Unnecessary Care
Overkill
An avalanche of unnecessary medical care is harming patients physically and financially. What can we do about it?
By Atul Gawande
Some snippets -- they don't do justice to the full article, but it's a start:
In his later years, my FIL *demanded* every possible test and procedure available so that he could "get better" -- this was an 80+ y.o. man whose body was failing, plain and simple. I suspect often times medical practitioners would prescribe medications or conduct tests in order to cover their a**es (or, to shut him up -- he was high-ranking military and could throw his considerable weight around). The FIL would shrug off the cost, blithely saying "Uncle will pay for it" (he had Medicare plus Tricare for Life). FIL was probably just one of scores of people demanding every means available to somehow reverse the ravages of time on the body. Sad, wasteful, and frustrating.
America's Epidemic of Unnecessary Care
Overkill
An avalanche of unnecessary medical care is harming patients physically and financially. What can we do about it?
By Atul Gawande
Some snippets -- they don't do justice to the full article, but it's a start:
[...]
The one that got me thinking, however, was a study of more than a million Medicare patients. It suggested that a huge proportion had received care that was simply a waste.
The researchers called it “low-value care.” But, really, it was no-value care. They studied how often people received one of twenty-six tests or treatments that scientific and professional organizations have consistently determined to have no benefit or to be outright harmful. Their list included doing an EEG for an uncomplicated headache (EEGs are for diagnosing seizure disorders, not headaches), or doing a CT or MRI scan for low-back pain in patients without any signs of a neurological problem (studies consistently show that scanning such patients adds nothing except cost), or putting a coronary-artery stent in patients with stable cardiac disease (the likelihood of a heart attack or death after five years is unaffected by the stent). In just a single year, the researchers reported, twenty-five to forty-two per cent of Medicare patients received at least one of the twenty-six useless tests and treatments.
[...]
One major problem is what economists call information asymmetry. In 1963, Kenneth Arrow, who went on to win the Nobel Prize in Economics, demonstrated the severe disadvantages that buyers have when they know less about a good than the seller does. His prime example was health care. Doctors generally know more about the value of a given medical treatment than patients, who have little ability to determine the quality of the advice they are getting. Doctors, therefore, are in a powerful position. We can recommend care of little or no value because it enhances our incomes, because it’s our habit, or because we genuinely but incorrectly believe in it, and patients will tend to follow our recommendations.
[...]
Another powerful force toward unnecessary care emerged years after Arrow’s paper: the phenomenon of overtesting, which is a by-product of all the new technologies we have for peering into the human body. It has been hard for patients and doctors to recognize that tests and scans can be harmful. Why not take a look and see if anything is abnormal? People are discovering why not.
In his later years, my FIL *demanded* every possible test and procedure available so that he could "get better" -- this was an 80+ y.o. man whose body was failing, plain and simple. I suspect often times medical practitioners would prescribe medications or conduct tests in order to cover their a**es (or, to shut him up -- he was high-ranking military and could throw his considerable weight around). The FIL would shrug off the cost, blithely saying "Uncle will pay for it" (he had Medicare plus Tricare for Life). FIL was probably just one of scores of people demanding every means available to somehow reverse the ravages of time on the body. Sad, wasteful, and frustrating.
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