Unnecessary tests and treatments in healthcare
The goal of every clinician is to help their patients become as healthy as possible. When a patient breaks an arm, for example, we all share the same preferred outcome: we want to heal the broken bone and restore normal function to the arm. Many times, the cost of achieving the preferred outcome varies widely, often depending upon where the patient lives. Some clinicians in one area may use more tests and treatments to achieve the same outcome that other clinicians achieve at a lower cost. When this occurs, clinicians may be performing services that are not necessary to achieve a successful outcome and may lead to harm. Eventually, unnecessary tests and treatments lead to raising the total cost of care for everyone.
When this occurs, healthcare experts call it “unnecessary variation.” I’ve written about it previously in DrAbelsonConnects from a scientific and economic perspective. (See “Healthcare and Zip Codes” and “The Cost Curve.”)
Another healthcare expert recently wrote about it from a personal perspective. Tara Parker-Pope is a 20 year veteran medical writer who reports on healthcare for The New York Times (and, previously, the Wall Street Journal). Parker-Pope has immersed herself in the minutia of healthcare practice and economics, and yet she found herself caught in a series of unnecessary and costly tests when her daughter sprained an ankle at dance camp. What should have required one, perhaps two visits to a clinic turned into a months-long ordeal. Here are excerpts from her column about the experience.
… At the time, the injury seemed unremarkable. Her pediatrician suggested waiting it out, but after a month with no improvement, I sought a second opinion from a sports medicine specialist, who ordered an M.R.I., but ended up referring her to a pediatric orthopedic surgeon.
The specialist examined the ankle and ordered another M.R.I. as well as extensive blood work. After seven vials of blood, my daughter nearly passed out.
A week later the doctor called. Some of the blood work looked uncertain, and he wanted to retest. After several more vials of blood, the results remained ambiguous. Even so, my daughter was referred to an eye specialist and a pediatric rheumatologist, who ordered more blood work and a third M.R.I. At the end of the appointment, the doctor noticed my daughter’s crooked pinkie fingers and, oddly, ordered an X-ray of her hands. Five months after twisting an ankle, my otherwise healthy daughter limped out of the radiology office carrying X-rays of her hands. “Mom,” she said, “my ankle still hurts.”
After years of reporting on health, I considered myself a well-informed patient, but it took my elementary-school daughter to state the obvious: She was the victim of too much medicine. Every new blood test, scan or X-ray raised new questions, which led to more lab work, scans and X-rays. I know the doctors had good intentions, but it’s a truism of modern medicine that the more you test and scan and look for problems, the more likely you are to find something wrong. My daughter’s case had spiraled out of control.
I canceled all her appointments with the various specialists, and went back to the sports doctor. We discussed a new approach that focused solely on pain relief. He consulted with my daughter’s pediatrician, and they agreed on a treatment. Within days, my daughter’s ankle had stopped throbbing, and soon she was back to sports and dancing.
Parker-Pope goes on to observe that her daughter’s treatment cost thousands of dollars and admits that she “lost track because it was all covered by my insurance.”
I admire Tara Parker-Pope for her candor in sharing this experience with millions of readers. And I agree with her that overtreatment and unnecessary variation of care is a pressing issue.
Recent medical research indicates that some tests and treatments are overused, do not improve outcomes and may expose patients to unnecessary risks. Earlier this spring, nine national medical societies identified 45 common tests and procedures that they say are overused and, in some instances, unnecessary, raising the cost of care for everyone without providing any benefit.
Even when these tests and procedures are covered by insurance, we all pay for it as a society and, ultimately, out of our own pockets. In the worst cases, this sometimes causes suffering as a result of medical complications or unnecessary anxiety as well as severe financial hardship and even bankruptcy. And it threatens to bankrupt our country if we don’t change our ways.
At Park Nicollet, we are developing new best practice protocols to ensure all of our tests and treatments provide benefit and eliminate any potentially unnecessary services that may occur here. This is an issue at many healthcare systems around the country and we want to ensure that it does not become an issue here. Eliminating unnecessary services also presents us with an opportunity to reduce the cost of healthcare without limiting treatment that provides benefit to people.
The era of healthcare reform is fast upon us. The pace of change is relentless and unforgiving. In order to thrive, healthcare systems must change their economic model to continue to provide outstanding care at more affordable prices.
Please feel free to comment. We encourage a free exchange of ideas but, as always, we reserve the right to remove comments that make personal criticisms or attacks on individuals or specific businesses.