Blog | Monday, May 13, 2013

Diagnostic skills can decrease health care spending


"Not everything that can be counted counts, and not everything that counts can be counted."
--Albert Einstein

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 Internal Medicine 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!

db is the nickname for Robert M. Centor, MD, FACP. db stands both for Dr. Bob and da boss. He is an academic general internist at the University of Alabama School of Medicine, and is the Associate Dean for the Huntsville Regional Medical Campus of UASOM. He also serves as a frequent ward attending at the Birmingham VA Hospital. This post originally appeared at his blog, db's Medical Rants.