Health care is currently undergoing much change. Unfortunately, the care provided in the United States ranks not as high as expected given the costs. The US health care system is the most expensive in the world. Yes, we have amazing medical centers here, and incredible research is done here, with successes seen every day. But, along with those successes come the harsh reality that care is uneven for the entire population, simply costs too much, and this is affecting our entire country.
Health insurance costs are through the roof. It costs so much for a family to comfortably cover health insurance costs, as to be prohibitive for many. Companies are struggling to be able to provide health insurance benefits to their workers and families. Some patients choose not to have health insurance due to excessive costs.
No one REALLY knows how much specific treatments and diagnostic tests cost (and even then, the costs vary significantly from place to place). Doctors order things every day, without understanding what the cost is to the patient and to society. Patients get billed for many different services that they may not even be aware of (e.g., a “facility” charge, a specialist charge, an imaging charge, as well as other costs hidden until the bill arrives).
This is a problem, and it is a massive one. But rather harping on “what is wrong with health care”, I prefer to take the high road. I prefer to highlight solutions—and one was just rolled out earlier today.
I am talking about the Choosing Wisely campaign. This is as good as it gets, and demonstrates that doctors and the organizations which they belong to want to try to fix some of the costs associated with care. Specifically, this initiative is looking to focus on the “overuse” in medicine that is so common today.
There are tests that physicians and other health care professionals order on patients which unfortunately have NOT been proven to improve care. In fact, sometimes these tests lead to more unnecessary tests, without improving outcomes. It is the outcomes that matter most.
The American Board of Internal Medicine Foundation (or ABIM Foundation, for short) worked with multiple medical organizations to determine 5 tests within each specialty which should NOT be ordered for common issues pertinent to that organization. In the first roll out, announced today, 9 specialties each discussed 5 tests which should be avoided in specific, common patient care scenarios. What a fantastic idea!!
While there may be other potential solutions for lowering the costs of health care, the reality is that it still is physicians and other health care professionals who order these tests. If they can decrease the ordering of unnecessary tests, costs will be reduced, plain and simple.
This is NOT rationing, in my opinion. It is simply working smarter to do things which are the right thing to do (or to avoid things which are the wrong thing to do). It means explaining to patients that a CT scan is not necessary for that headache. It means not ordering an MRI for that patient with low back pain who likely has a low probability of having a rare condition causing that pain. A simply way of explaining it is "first do no harm"--what I learned on the first day of medical school is still just as important as every other thing I learned.
Please support this cause. It is really a noble one, and should and will be promoted throughout medicine, whether it involves patients seen by primary care physicians or those seen by specialists. What I really like is the approach to roll this out not to just the physicians and medical organizations, but to the lay public as well. It will also be mentioned in Consumer Reports later this year.
Support the Choosing Wisely cause. It is an example of physicians choosing to put what is right and what they can do right now to improve health care first, and their own pocketbooks second. I know that I will put it into practice immediately, especially when seeing patients and teaching medical trainees at the point of care.
For a list of the 45 statements from the 9 organizations, click here.
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