Fixing health care – some data

7

Category : Fixing health care

Over the next week or three, I plan to address health care in the United States.  I have not researched the issue; I have lived the issue.  My comments come from the heart and my version of common sense.  Since I am a physician, I will first present the data that I consider the most important.  I will then provide my diagnosis.  Finally in a long series of rants I will provide a variety of solutions.

I start from the assumption that our current health care “mess” has many etiologies.  We have no simple solution, because we cannot blame our current state on one problem.  I invite criticism and will even be delighted to “publish” op-eds on any of my rants.

Some data:

1. Health care is expensive

2. Sometimes it is worth it, but sometimes the expense is unnecessary

3. Our ability to improve quality of life has grown dramatically over the past 30 years

4. Our ability to manage many chronic diseases has grown dramatically over the past 30 years

5. In general we have too high a proportion of medical school graduates entering subspecialties and not enough entering generalist fields

6. Physicians do not spend enough time with patients (i.e., they see too many patients each day)

7. Physicians who do things are paid better than physicians who think through complex problems (again this is a generalization, many physicians who do things think first)

8. We generally prescribe too many drugs, and particularly too many expensive drugs

9. We overuse imaging technology, and do not take the time to take a careful history and do a careful physical examination

10 Patients are frustrated.  Many cannot find a physician (this is especially true for internists and the problem is worsening.)

11. Physicians are frustrated by malpractice, health insurance companies, and performance measurement

12. Everyone desires high quality medical care, but current proposals only include one or two dimensions of a multidimensional problem

13. We are still graduating too few physicians each year in the US

Yet, when pushed, most patients like, respect and trust their physician and most physicians love taking care of patients.

I certainly encourage readers to add to this list, as it is clearly incomplete.  Some will want me to address the underserved.  Clearly that is a problem, and I hope my solutions will address that issue, but even if you exclude that issue, we have great strides to make.

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Comments (7)

DB, great start to the list.

I would like to add the social factors as well. It is very easy to blame doctors, lawyers, politicians, insurance companies, etc. etc.etc…. (all of which are defiantly involved.)
But, we can not ignore our societal problems.

1. Americans demand the very best, but genrally dont want to pay for it.
2. Americans have a high sense of entitlement and a low sense of responsibility
3. Americans are overly sensitive. i.e: We are ready to give up when a few “eggs” crack.

I firmly believe the problem will not be fixed until WE all as society start accepting some responsibility.

thanks for the post.
brian

Great list.

I would only add that doctors need a broad based business knowledge when graduating from medical school.

One of the many surprises I have had in following the medical blogs is that doctors look to pharma, insurance companies, or hospitals for their business models. None of these are really appropriate for the stand alone private practice. Plus, doctors are often taken in by those who put their interest above that of the doctor or their patients.

If I could teach them only one thing, it would be their role as sales managers, in their new profession.

Steve Lucas

I would add that for many treatments, we are dealing in the diminishing returns part of the curve.

Many of the new, expensive treatments and meds don’t add that much to what we were already doing with older proven treatments and generic meds, but we all want “the best” so it becomes the new standard of care. this costs us a ton and gives us relatively little benefit.

The List . . ….

A fellow blogger started a list. Here are just a few of the things on . . . the list….

DB,
I agree with your list, but I do not agree with your premise, that our health care system is a mess. In America, you, as a patient can get in to see any physician (you may have to wait) for any procedure at any time you desire. The only impediment is cost. This is a false impediment, as most people would think nothing of spending $20,000.00 on a new car but believe that health care should not cost. As Brian, stated, Americans want the best, but do not want to pay for the best. As someone who has experience “socialized medicine” in the military system, I will gladly pay for the right to control my own medical treatment. Finally, as a medical office manager, our patients demand the best service, but do not want to pay for the services. My solution to the problem is to put the responsibility back where it belongs, the patient. I will be curious to see what your solutions are.
Kelley

Well said, pcb- Even in a best case scenario, any of our standard of care practices can only expect to benefit a few patients a little bit. And significant amounts of publication bias (described in last weeks NEJM) likely reduces the expected effectiveness of treatments even more. Physicians (and patients) have demonstrated very little ability to distinguish between high-value interventions and low-value interventions for individual patients (or groups of patients). So instead we recommend ALL the possible interventions that might have any impact on health (regardless of the known problems with overtesting, overdiagnosis and overtreatment)
I went to a Merck sponsored lunch last week where the physican presenter (on Merck’s dime) was trying to convice us of the utility of Vytorin. When asked about the expected absolute risk reduction for lowering LDL from 100 to 70, he dismissed the questioner and said “If you looked at ARR, you wouldn’t do half of the things we do in cardiology!”- I couldn’t agree more-

REASON IO CHANGE HEALTH CARE 1. GET RIDE OF VETERAN HEALTHCARE
VETERAN NEEDS SPECIAL CARE
WHY DO VETERAN NEED IT -BIOCHEMICALS RAIDTION,NUCLAR, DU,A/O
mILITARY NEED NOT TELL WHAT IS HAPPENING TO THEM
tHEY WILL DIE.
WVETS

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