Blog | Thursday, July 5, 2012

Cut health care costs by starting with the annual exam

Today's New York Times has an article everyone should read. Let's (Not) Get Physicals.

While the entire article is well researched and written I particularly like these paragraphs:

"In a report released last month, the Commonwealth Fund pointed to a heavy reliance on specialists in the United States as a central factor in driving up costs. Americans have far fewer doctor visits on average than patients in places like Japan and Denmark. But they see more specialists and get more tests.

Specialists are generally inclined to use the tools--and newest toys--of their trade. Surgeons operate. Radiologists conduct scans. Interventional cardiologists do angiograms and stent placements to hold open arteries. "When you go to Midas you get a muffler," we said when I was in medical training.

"If you have back pain, maybe a primary care doctor says take a muscle relaxant and do these exercises," Ms. Davis said. "But in the U.S. you might say 'my friend went to this doctor and had surgery and it's better.' So you make an appointment with a back surgeon but before you see the surgeon, you must have a scan. There's less of what doctors call 'watchful waiting.' "


"A recent study in the Annals of Emergency Medicine found that 10 percent of Americans get CT scans each year and that the use of CT scans in emergency departments has increased sixfold in little over a decade. The Choosing Wisely program recommends against the common practice of conducting X-rays or scans on patients with simple back pain that is less than six weeks old. Virtually all people over 50 will have abnormalities on such tests, and most back pain gets better without surgery.

Consciously or subconsciously, experts say, commercial interests foster unneeded tests. Studies show that doctors who invest in radiology machines are more likely to order X-rays, for example.

We must do better. We cannot control costs without major changes. We must develop a health system. We must work together rather than independently. Only by transforming health care into systems can we rein in costs.

The challenge is ours to take. I hope we have the strength and wisdom to do the right thing.

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.