Wednesday, October 14

America’s Epidemic of Unnecessary Care


Well. You'll go through what I went through and to a lesser extent going through with your grandfather. We rely on doctors to tell us what to do. If I knew more about medicine I could challenge but I don't. So I just go with whatever they say. Look at mum. She's suffering from a frozen shoulder for the past year and countless trips to the doctor hasn't fixed the issue. Tests and poking and and and nothing. One of my friends keeps moaning about the epidemic of tests that the NHS orders here in the uk and fulminates against the quacks in London. But lessons learnt son. We need to ask more. And challenge more. Sometimes it's better not to do anything. But it needs some faith in yourself and the knowledge that sometimes you will make a mistake. And that's the problem. If you don't test, operate or what have you, what if you were wrong and it goes bad? 

You know I suffer from hidranitis suppurativa. It's a problem with the endocrine glands and manifests itself in skin lesions who are horrendously painful. And then I've got to gobble painkillers like candy to get through the day. There's no cure. The only cure that the doctors said was to surgically remove the skins from around my groin and armpits. Which would be sodding disaster. So I told them to bugger off. I take turmeric. Stopped smoking. Cut out red meat. Stopped taking sugar. Am physically active. Switched from briefs to boxers. And and and. Surgery isn't fun son. Having gone through a few, it's painful. 

Anyway you may have to decide for me or mum. So this article gives you some useful guidance on how to handle Medical treatments and say No sometimes. 



America’s Epidemic of Unnecessary Care
(via Instapaper)

Millions of Americans get tests, drugs, and operations that won’t make them better, may cause harm, and cost billions.
Millions of Americans get tests, drugs, and operations that won’t make them better, may cause harm, and cost billions.

It was lunchtime before my afternoon surgery clinic, which meant that I was at my desk, eating a ham-and-cheese sandwich and clicking through medical articles. Among those which caught my eye: a British case report on the first 3-D-printed hip implanted in a human being, a Canadian analysis of the rising volume of emergency-room visits by children who have ingested magnets, and a Colorado study finding that the percentage of fatal motor-vehicle accidents involving marijuana had doubled since its commercial distribution became legal. The one that got me thinking, however, was a study of more than a million Medicare patients. It suggested that a huge proportion had received care that was simply a waste.

The researchers called it “low-value care.” But, really, it was no-value care. They studied how often people received one of twenty-six tests or treatments that scientific and professional organizations have consistently determined to have no benefit or to be outright harmful. Their list included doing an EEG for an uncomplicated headache (EEGs are for diagnosing seizure disorders, not headaches), or doing a CT or MRI scan for low-back pain in patients without any signs of a neurological problem (studies consistently show that scanning such patients adds nothing except cost), or putting a coronary-artery stent in patients with stable cardiac disease (the likelihood of a heart attack or death after five years is unaffected by the stent). In just a single year, the researchers reported, twenty-five to forty-two per cent of Medicare patients received at least one of the twenty-six useless tests and treatments.

Could pointless medical care really be that widespread? Six years ago, I wrote an article for this magazine, titled “The Cost Conundrum,” which explored the problem of unnecessary care in McAllen, Texas, a community with some of the highest per-capita costs for Medicare in the nation. But was McAllen an anomaly or did it represent an emerging norm? In 2010, the Institute of Medicine issued a report stating that waste accounted for thirty per cent of health-care spending, or some seven hundred and fifty billion dollars a year, which was more than our nation’s entire budget for K-12 education. The report found that higher prices, administrative expenses, and fraud accounted for almost half of this waste. Bigger than any of those, however, was the amount spent on unnecessary health-care services. Now a far more detailed study confirmed that such waste was pervasive.

I decided to do a crude check. I am a general surgeon with a specialty in tumors of the thyroid and other endocrine organs. In my clinic that afternoon, I saw eight new patients with records complete enough that I could review their past medical history in detail. One saw me about a hernia, one about a fatty lump growing in her arm, one about a hormone-secreting mass in her chest, and five about thyroid cancer.

To my surprise, it appeared that seven of those eight had received unnecessary care. Two of the patients had been given high-cost diagnostic tests of no value. One was sent for an MRI after an ultrasound and a biopsy of a neck lump proved suspicious for thyroid cancer. (An MRI does not image thyroid cancer nearly as well as the ultrasound the patient had already had.) The other received a new, expensive, and, in her circumstances, irrelevant type of genetic testing. A third patient had undergone surgery for a lump that was bothering him, but whatever the surgeon removed it wasn’t the lump—the patient still had it after the operation. Four patients had undergone inappropriate arthroscopic knee surgery for chronic joint damage. (Arthroscopy can repair certain types of acute tears to the cartilage of the knee. But years of research, including randomized trials, have shown that the operation is of no help for chronic arthritis- or age-related damage.)

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