Some time ago, I created a list of ways that the newly-elected President Obama could save money for the American medical machine. The blog post “Ways to Save Millions of Dollars in Obstetrics” is here. People who work day to day within the business of medical services can see things to which others are blind. Today on Medscape, I was interested to read the following post from a doctor who has looked into the areas he is familiar with and has come up with 7 items that could make a huge difference. Some of them involve women’s health. This one, in particular, defies all the brainwashing women have received for the past 30 years:
Screening mammography should be stopped in women younger than 50 who have no clinical indication and sharply curtailed for those over 50, because it now seems to lead to at least as much harm as good. More billions saved.
I’m 62 years old and I’ve been fortunate to only have one mammogram in my life. I’ve always thought it was against logic to use cancer producing x-radiation to diagnose cancer. When I did have my mammogram (at about age 43 and after having a needle biopsy for a lump in my breast that turned out to be benign, thankfully) I went in to the clinic by myself (mistake, always take an advocate with you). I walked right past a big sign that said “If You’re Pregnant, Please Inform the Technician”. I wasn’t pregnant so I thought nothing of it. I was halfway through the mammogram when I realized that I wasn’t wearing a lead apron to protect my ovaries. When I told the technician I wanted to stop and put one on, she got quite snippy with me. I explained to her that I was not pregnant but that I was still of childbearing age and, even if I was menopausal, what would be the harm in lessening my exposure? I’m sure if I’d taken one of my midwife friends with me, she would have been watching out for things like that and protecting me before I was halfway done.
I also find it worth pondering when Dr. Lundberg advises:
We must stop paying huge sums to clinical oncologists and their institutions for administering chemotherapeutic false hope, along with real suffering from adverse effects, to patients with widespread metastatic cancer. More billions saved.
I have a friend who is a registered nurse in a big American city. She does home visits and care for people in end stage cancer. She tells me that the doctors instruct her patients to get up and go to the bus stop at 4:00 a.m. to get their chemo at the hospital by 6:00 a.m. Often they die the day after their last chemotherapy. What kind of cruel and unusual punishment is that?
I’ll print the whole item from Medscape in case you can’t access the link. From Medscape Internal Medicine Seven Ways to Reduce Unnecessary Medical Costs — Right Now!
George D. Lundberg, MD
Published: 08/24/2009
http://www.medscape.com/viewarticle/707769?src=mp&spon=17&uac=90810CY
I believe that there are still many ethical and professional American physicians and many intelligent American patients who are capable of, in an alliance of patients and physicians, doing “the right things.” Their combined clout is being underestimated in the current debate on healthcare reform.
Efforts to control costs in the US healthcare system date from at least 1932. With few exceptions, they have failed. Healthcare reform, 2009 politics-style, is again in trouble over cost control. It will really be a shame if we once again fail to cover the uninsured because of hang-ups over costs.
Physician decisions drive most expenditures in the US healthcare system. In this system, costs will never be controlled until most physicians are no longer paid fees for specific services. The lure of economic incentives to provide care that is unnecessary, unproven, or even known to be ineffective encourages many physicians to make the lucrative choice. Hospitals and especially academic medical centers are also motivated to profit from many expensive procedures. Alternative payment forms used in integrated multispecialty delivery systems, such as those at Geisinger, Mayo, and Kaiser Permanente, are far more efficient and effective.
Fee-for-service incentives are a key reason why at least 30% of the $2.5 trillion expended annually for US healthcare is unnecessary. Eliminating that waste could save $750 billion annually, with no harm to patient outcomes.
Currently, several House and Senate bills include various proposals to lower costs. But they are tepid at best and in danger of being bought out by special interests at worst.
So what can we, in the United States, do right now to begin to cut healthcare costs?
An alliance of informed patients and physicians can widely apply recently learned comparative effectiveness science to big-ticket items, saving vast sums while improving quality of care.
Intensive medical therapy should be substituted for coronary artery bypass grafting (currently around 500,000 procedures annually) for many patients with established coronary artery disease, saving many billions of dollars annually.
The same for invasive angioplasty and stenting (currently around 1 million procedures per year), saving tens of billions of dollars annually.
Nonindicated prostate-specific antigen screening for prostate cancer should be stopped. Radical surgery as the usual treatment for most cases of prostate cancer should also cease because it causes more harm than good. Billions saved here.
Screening mammography should be stopped in women younger than 50 who have no clinical indication and sharply curtailed for those over 50, because it now seems to lead to at least as much harm as good. More billions saved.
Computed tomography and magnetic resonance imaging scans are impressive art forms and can be useful clinically. However, their use to guide therapeutic decisions is unnecessary much of the time. Such expensive diagnostic tests should not be paid for on a case-by-case basis but could be bundled together with other diagnostic tests by some capitated or packaged method that is use-neutral. More billions saved.
We must stop paying huge sums to clinical oncologists and their institutions for administering chemotherapeutic false hope, along with real suffering from adverse effects, to patients with widespread metastatic cancer. More billions saved.
Death, which comes to us all, should be as dignified and free from pain and suffering as possible. We should stop paying physicians and institutions to prolong dying with false hope, bravado, and intensive therapy that only adds to their profit margin. Such behavior is almost unthinkable and yet is commonplace. More billions saved.
Why might many physicians, their patients, and their institutions suddenly now change these established behaviors? Patriotism, recognition of new science, stewardship, and the economic survival of the America we love. No legislation is necessary to effect these huge savings.
Physicians, patients, and their institutions need only take a good, hard look in the mirror and then follow the medical science that most benefits patients and the public health at lowest cost. Academic medical centers should take the lead, rather than continuing to teach new doctors to “take the money and run.
“Physicians can reaffirm their professionalism with sound ethical behavior and without undue concern for meeting revenue needs. The interests of the patients and the public must again supersede the self-interest of the learned professional.George Lundberg, MD
Dr. Lundberg is president and board chair of The Lundberg Institute.
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