More on decreasing health care costs – start with the yearly physical exam

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Category : Medical Rants

Today's NY Times has an article everyone should read.  Let's (Not) Get Physicals

While the entire article is well researched and written I particularly like these paragraphs:

In a report released last month, the Commonwealth Fund pointed to a heavy reliance on specialists in the United States as a central factor in driving up costs. Americans have far fewer doctor visits on average than patients in places like Japan and Denmark. But they see more specialists and get more tests.

Specialists are generally inclined to use the tools — and newest toys — of their trade. Surgeons operate. Radiologists conduct scans. Interventional cardiologists do angiograms and stent placements to hold open arteries. “When you go to Midas you get a muffler,” we said when I was in medical training.

“If you have back pain, maybe a primary care doctor says take a muscle relaxant and do these exercises,” Ms. Davis said. “But in the U.S. you might say ‘my friend went to this doctor and had surgery and it’s better.’ So you make an appointment with a back surgeon but before you see the surgeon, you must have a scan. There’s less of what doctors call ‘watchful waiting.’ ”

and 

A recent study in the Annals of Emergency Medicine found that 10 percent of Americans get CT scans each year and that the use of CT scans in emergency departments has increased sixfold in little over a decade. The Choosing Wisely program recommends against the common practice of conducting X-rays or scans on patients with simple back pain that is less than six weeks old. Virtually all people over 50 will have abnormalities on such tests, and most back pain gets better without surgery.

Consciously or subconsciously, experts say, commercial interests foster unneeded tests. Studies show that doctors who invest in radiology machines are more likely to order X-rays, for example.

We must do better.  We cannot control costs without major changes.  We must develop a health system.  We must work together rather than independently.  Only by transforming health care into systems can we reign in costs.

The challenge is ours to take.  I hope we have the strength and wisdom to do the right thing.

Comments (3)

"Virtually all people over 50 will have abnormalities on such tests, and most back pain gets better without surgery."
Not only does it get better without surgery, it doesn't get better WITH surgery.

The bias on blaming only specialist in over testing is too much; the problem starts as soon as a referral is made. If i am asked to see someone for SOB, how is getting a CxR and PFTs before I see the patient over testing? Around 50% of patients carry a wrong diagnosis of COPD/Asthma and continue to use inhalers without any benefit…..who gave them those medicines without proper diagnosis? we have created a system where we blame each other while never looking in ourselves. 

[…] week I wrote about a NY Times article criticizing the annual physical.  Today's NY Times includes letter to the editor that criticize the article – Making […]

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