Welcome to the RightCare Weekly, a newsletter that will help you stay on top of all the important news in the ongoing quest to move the U.S. health care system toward the right care. We’ll bring you the most important stories, news articles, and opinion pieces of the week, along with our interpretation of why they’re important and what they mean for patients, doctors, and communities.
First up, Vikas Saini and Shannon Brownlee of the Lown Institute have coauthored a blog post with Christine Cassel, over at the Health Affairs blog: When Less Is More: Issues Of Overuse In Health Care. The post gives a broad overview of the state of overuse in the US health care system, and is a great resource to suggest to friends or colleagues who are interested in learning a little more about the issue!
Andrew Pollack’s provocative New York Times story on doctors considering the cost of treatments when creating clinical guidelines is the latest in a long-standing debate: what role should costs play in guiding medical practice? While it’s important to control spending in the health care system as a whole, making guidelines based on cost-effectiveness – or worse, pressing individual doctors to make ad-hoc decisions about whether society’s needs should override their patient’s – isn’t the right answer. The best way to reduce health care spending is to stop wasting money on things that don’t work, or cause harm. But in addition to reducing overuse, we need to create places in civil society to make decisions about what treatments are worth while – and those conversations need to make clear what we’re giving up in exchange for low-value medical spending.
Next, a Kaiser Health News story by Jordan Rau pointed out that, while the Choosing Wisely campaign has drawn a lot of attention to overuse, it hasn’t focused on the lucrative procedures that waste huge amounts of money in the medical system – and feed some doctors’ large paychecks. The story is important not least because it demonstrates how broad the problem of overuse is. The Choosing Wisely lists now cover hundreds of distinct procedures that aren’t evidence-based, but there are still many more that the health care system has been less willing to give up. That doesn’t even start to address how the culture of overuse encourages unnecessary hospitalizations and other behaviors that are much harder to call out than individual procedures.ABIM Foundation Vice President Daniel Wolfson has responded to the story, and rightly points out, “the usefulness of a medical test or procedure should be gauged by the outcomes it achieves for patients, not the income it generates for the health system.”
We read a while ago about a surgeon who said, when an uninsured patient asked about treating his appendicitis with antibiotics (cheap) instead of surgery (expensive), “This is America, not Sweden. We operate.” Leaving aside the jingoistic assumption that choosing more intense treatment is a badge of honor for the US health care system, the surgeon’s indifference was a striking example of easily our health care system misses the huge number of other circumstances in a patient’s life that determine what it means for them to get good care.We were reminded of that story this week, because the drug treatment option got a bit of a boost: in a new study of a small group of children, most of the kids with appendicitis were treated successfully with antibiotics. While costs shouldn’t force parents to accept less-effective treatment options for their kids, clinicians should be open to the possibility that sometimes, avoiding surgery (and the recovery time, lost time in school, and other costs that come with it) might be the right choice. Medical orthodoxy shouldn’t be used to overrule reasonable patient preferences.
Finally, Shannon Brownlee spoke a few weeks ago at the Universal Health Care Foundation of Connecticut’s Reform to Transform event. You can see some of the video from the event here.
EDIT: Yesterday, the Choosing Wisely campaign released the results of a survey which found that 1 in 5 doctors in the US knows about the campaign, and most of those docs said they’re less likely to order tests and treatments that are on the lists of things to avoid. Jordan Rau has complete coverage for NPR.