A snippet in our local newspaper about too many invasive heart tests with two few positive results has given way to a broader A/P piece (Lindsey Tanner) that suggests even President Obama is getting too many diagnostic tests, as evidenced by his recent virtual colonoscopy and prostate cancer screening. The article highlights unnecessary diagnostic increases created by the “defensive” medicine practiced in America to avoid malpractice suits and the greater appetite for care generated by an informed public seeking the latest in advanced technology. But as Dr. RIta Redberg, editor of the Archives of Internal Medicine and a cardiologist herself points out, “more care is not necessarily better care”, though “people have come to equate medical tests with good care and prevention”. The article goes on to say that some doctors and advocacy groups do not subscribe to the “less is more” philosophy and believe that saving even a few lives is worth the cost of screening thousands. I wonder…
After a lifetime in healthcare I’ve seen a great deal of practice styles and systems. I’ve seen what defensive care does to medical practice in America, and I’ve also seen practice in countries where the threat of lawsuits is minimal and “negligence” more specifically defined. Along the way I’ve encountered the “tinkerers” who keep diagnosing until they find a reason to prescribe something, those with “better ideas” who simply can’t abide the treatment prescribed by another physician, and those who seem to think surgery is always the only option. My own physician ordered a $2200 endoscopy for me because I “should” have it at my age…I respectfully declined and took the cruise instead.
In fairness, I’ve seen all kinds of patients too: those that want a “specialist” for everything, others with prescriptions from every doctor within a ten mile radius, and those who simply have nothing better to do than visit the doctor or their local Emergency Room. Advocacy groups sometimes encourage decades long diagnostic behaviors, such as routine mammograms, only to later decide the radiation exposure is itself a serious risk. There’s also “alternative medicine” with everything from aroma-therapy to cupping (similar to the “bleeding” techniques used in previous centuries), not to mention the well-advertised “over-the-counter” trade for every conceivable ache and pain. Where does healthcare begin and where does it end? Where should it end? What is enough? And when it comes to health, where happens to our common sense?
Many of us use medical diagnostics as a gauge. We want to know if lifestyle elements like smoking, cholesterol, salt, alcohol, sun and a host of other not-so-healthy practices are catching up with us, to see if it’s time to make the lifestyle changes and implement the preventions we know make sense and we know we need. If the tests come back within reasonable limits we know we can live on the edge just a little longer. Then one day there’s the chest pain, the lump, or the “spot” on the diagnostic image and suddenly we’ve had our conversion experience. Then no cost is too great for a medical miracle.
Until a health crisis occurs people tend not to change, but healthcare must change. While research and technology have made incredible advances in diagnosis and treatment, everything has it’s limits and the limit is cost. Roughly 40% of an American’s lifetime healthcare expenditure occurs during the last six months of life, most of it spent on “last resort” treatment. Healthcare does need an overhaul, but it begins with individuals taking responsibility for their own health, facing consequences of lifestyle and behaviors, and adopting realistic expectations for end-of-life care. At some point it’s up to the individual to say “enough”.
The face is, cost is a healthcare driver that can no longer be ignored. We cannot make believe there are no limits to the technology a society can afford, and we cannot keep developing solutions with unrealistic price tags. All the latest, most innovative diagnostics and treatments are to no avail if they are so costly that they are reserved for only the most affluent, those with the best insurance, or those in a privileged society. True healthcare innovation must be simple, quick and affordable…available to everyone, not just those born within fortunate geopolitical boundaries. Most important, healthcare innovation must refocus from end-of-life treatment to early prediction and early prevention when counter measures are cheap and effective.
No, more healthcare is not necessarily better healthcare. There comes a point when enough is enough.
