Diagnostic skills can decrease health care spending

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Category : Medical Rants

When policy wonks and legislators talk about bending the health care cost curve, they often stress quality. They then assert that we can measure quality and incent that same quality, with important positive results. Too often I have listened to this mantra – control health care costs by paying for quality.
Long-time readers know that I become agitated when the wonks assert that they can measure quality (they are only measuring performance which is a small part of quality) and decrease costs with that strategy.
So I will assert that the key to decreasing health care spending involves taking care in the diagnostic arena. My observations, while anecdotal, suggest that we spend too much money on diagnosis. Too often we resort to expensive imaging; too often we start treating one diagnosis instead of carefully establishing a diagnosis. We have too many diagnostic errors, or delayed diagnoses.
Talking with a wonderful colleague while at IM 2013 in San Francisco, he suggested that too often he sees patients who have not had a sufficient history, physical exam, or thought process. Careful and thoughtful diagnosis takes time. In too many emergency departments, a protocol exists that allows a triage nurse to order an abdominal CT prior to a careful history and exam.
Why are the suits obsessed with performance and not diagnosis?
Oh, measuring the accuracy of diagnosis is very difficult!
“Not everything that can be counted counts, and not everything that counts can be counted.” – Albert Einstein

Comments (1)

How many times do we see presumed diagnosis treated like solid diagnosis with toxic medicines which end up actually harming more often than helping and ultimately confounding the overall picture? In the eagerness to help, a lot of times we end up hurting. The right way should be -” if something is working, keep doing it; if something is not working stop doing it and if you don’t know what to do, don’t do anything.”

This applies well to MBAs too – if they cannot stop doin it, they will be better off not doing anything.

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