| Lifelong Health: Medical Extravagance Pushes Up Health Costs An 89-year-old man who plays golf every day went to Florida on vacation. While there, he developed significant back pain and went to see a family physician. While giving his medical history, he indicated that he became somewhat short of breath near the end of 18 holes of golf.
He was immediately referred to both a back specialist and a cardiologist. Within three days, he had a CT scan of the back, a CT scan of his heart and an echocardiogram. Though he had a normal stress test, his heart revealed some abnormalities on the CT scan, so the cardiologist recommended an angiogram. In the meantime, his back pain was largely resolved with scheduled acetaminophen (generic Tylenol). After talking with his wife, he decided that he would wait until he got home to make any further decisions.
This story highlights what is wrong with health care in our country. It is not that we do too little, but that we do too much! And the end result can often be detrimental to the patient. While there might have been some indication to do an X-ray of the back, recent recommendations state that CT scans and MRI of the back should only be done if there is weakness of the lower limbs.
And what about his extensive cardiac work-up? A relatively healthy man in his 90th year who can complete a round of golf with minimal breathlessness should be left alone. At his age, it is not surprising that the CT scan of the heart was significantly abnormal, and the value of this test in anyone over the age of 70 is questionable.
Who knows what the next step would have been if the stress test was positive and an angiogram was abnormal? He may have had stents placed. And being such a healthy 89-year-old, surgery could have been recommended. Recent reviews of invasive cardiac procedures for individuals over the age of 80 indicate that many tolerate the procedures quite well, despite the risk of side effects. Experts in the field emphasize that any invasive procedure on the heart must only be done to improve the quality, not the longevity, of life.
In recent years, the burgeoning cost of health care -- especially in Medicare and Medicaid -- has been pushed to the forefront of national politics. Curbing the national debt will only come through major overhaul to these entitlement programs. But what and where to cut? Sadly, all the wrong people who have little knowledge of health care will be making these decisions. The practicing physicians who understand the problems have been virtually silent.
True health care change has little to do with politicians and lawmakers. The changes must come in the clinic with doctors making the right decisions based on sound scientific evidence of benefit. In fact, the very foundation of American medicine must change. Every patient must have a physician who specializes in primary care, is capable of dealing with chronic medical problems, and can coordinate appropriate care with specialists. Academic medical leaders and thoughtful advocates in the insurance community are already supporting this change and are urging the development of the "medical home" where this kind of practice becomes the norm.
Technology will play an important role in making changes that succeed. We must have an easily accessible electronic medical record, which would have allowed the physicians in Florida to become aware of my patient's medical records in Arkansas. For most medical issues, specialists should help the primary care physician manage a difficult problem. Once the core illness is addressed, further visits to the specialists are superfluous.
In addition, we need incentives for all physicians to practice the right care. No physician should be rewarded by how many tests are done or procedures performed. Doctors should have intensive education and oversight to assure that every treatment plan is justified and rational.
Perhaps, the most important step to ensure health care reform is to be educated about your health. You must know how to navigate the health care system -- know what questions to ask, what side effects are possible and what outcomes to expect. By studying the problem in detail and being involved in every health care decision, you will not only improve your health, but you will also save our health system from unnecessary, inappropriate and irrational care.
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Dr. David Lipschitz is the author of the books "Breaking the Rules of Aging" and "Dr. David's First Health Book of More Not Less." To find out more about Dr. David Lipschitz and read features by other Creators Syndicate writers and cartoonists, visit the Creators Syndicate Web page at www.creators.com. More information is available at www.DrDavidHealth.com. Copyright 2011 Creators Syndicate Inc. |
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