Monday, March 2, 2009

Blogger Tara Parker-Pope in today's NY Times' Well section entitled A Hurdle for Health Reform: Patients and Their Doctors, discusses that in order to cut health care costs, doctors and patients are going to have realize that the newest treatments and medications don't always equate to the best care.
Though I disagree somewhat with her focus on prescription drugs ( her example that "most hypertension patients still use costlier drugs marketed by pharmaceutical companies" is not entirely accurate since most hypertension drugs are now generic, and insurers have made it much more difficult lately to get the newer, more expensive drugs); however, her sentiment is right on target. If we want to lower health care costs, then everyone can't get everything. In certain cases, some degree of rationing is going to have to occur. However, in many cases just using good scientific evidence will do the trick. Here are just a few things that patients can do to reduce health care costs now:
1. Don't demand antibiotics. As I have written before, colds are caused by viruses which do not respond to antibiotics. Most viruses take a week or so to resolve. Just because you still feel bad after a few days does not mean you need an antibiotic. A common thing I hear from patients is "when I get this sick, the only thing that makes me better is an antibiotic." Remember that colds resolve on their own, so if you start the antibiotic on day #7, was it the antibiotic working or the cold resolving on its own? Also, the placebo effect is about 30%. Doctors realize that the reason patient come in when they are sick is that they have tried the usual remedies and want to feel better. However, in most cases, rest, fluids and over the counter medications, as well as time, is what works best when you are sick.
2. MRI doesn't necessarily mean best test. Some patients have a notion that a CT scan is better than an X-ray and an MRI is best. MRI is certainly one of the most expensive tests, but not necessarily the best. One of the best imaging studies to look at bones are plain old X-rays. Imaging is based more on what you are looking for, not which is the best test. One of the biggest drivers of health care costs is diagnostic imaging. Many studies are simply not needed. In addition, especially in the case of CT scans, exposure to radiation is not necessarily without potential harm.
3. Patients have to accept watchful waiting. There are certainly true emergencies where hours or even minutes are critical and some study or procedure must be done right away. However, these situations are rare. Demanding that studies be done ASAP adds to costs because often symptoms resolve on their own. Though reassurance and peace of mind may be worth something, in many instances this is breaking the health care bank.
4. Spend out of pocket money on things that work. There's no question that health care is just too expensive for the average American, and asking the general population to help foot the bill seems ridiculous. However, while patients are paying a lot in premiums and co-pays, they are also spending billions of dollars on thing that have not been proven to work, and in some cases may be harmful. I have blogged before about vitamins and natural cold remedies that likely do nothing to improve health. If we took all the money that patients spent on vitamins, supplements, diet pills, pills that enlarge your penis, etc. (excluding things known to be useful like Calcium and Vitamin D), this would add up to billions of dollars that could be used for things proven to save lives like mammograms, colonoscopies, and smoking cessation treatments. I believe if we regulated all health products like medications and devices, this would decrease costs in the long run. Given that the manufactures of these products gave $3 million in campaign contributions in 2008, I doubt that this is going to happen any time soon.
5. We need malpractice reform. It is hard to measure the number of unnecessary tests doctors order because they fear getting sued. Part of this has to do with the fact that, in general, the public feels that every test ought to be ordered even when there is only the smallest possibility of a potential disease. More importantly, bad things do happen, even when the correct decision is made, and we currently have no system set up to compensate patients when bad things do happen, other than to sue their doctor. This is not something that patients can do per se, but they can support a system that replaces our current one.


Duncan Cross said...

Tara Parker-Pope's article was about whether doctors and patients are ready for reform - not just patients. It's a bit patronizing and not at all helpful to suggest from there that patients carry all the water when it comes to reducing costs. However, I would be interested to see a little introspection: what can doctors do right now to help reduce costs?

Dr. Matthew Mintz said...

Point well taken. I didn't mean to imply that doctors don't have role in this.
I think malpractice is a bigger issue than is being given credit.
For example, it is hard for me to recommend that doctors not cave to a patient who is requesting an unnecessary MRI when there is no real incentive not to order this, and a very real issue that in the rare chance that something does eventually turn up, the doctor could be sued and ruined for life.
That said, I think doctors should be more concerned about the cost of things that the order or prescribe.

Anonymous said...

why would a Dr order a bone density test on a patient who is bed ridden and unable to walk via a stroke and is mentally uncapable to function and 94 years old.

Anonymous said...

Alternative view of Vitamin D. (scroll down a bit)

Black-White Differences in Cancer Risk and the Vitamin D Hypothesis