Category: cost

Fast Food Medicine

“Would you like fries with that?” 
“Would you like to upgrade to a large soda instead of a medium?”
“Would you also like an additional blood test for Lyme disease?”

Sure why not? I love fries!
And a larger drink? Heck yeah, if it’s only a few cents more.
I’ll also take that Lyme disease test, just to be on the safe side!
The above sounds like a great fulfilling experience.
You get delicious inexpensive food, served by very pleasant and efficient people that were also willing to cater to whatever you want. You also get a doctor who seems to really care and thorough by ordering a battery of tests. It’s the kind of experience and place that anyone would want to keep coming back to, again and again.
This is not the typical experience many patients (consumers?!?) have when they interface with our general healthcare system. Healthcare is not inexpensive, not convenient at all and the quality of the product is variable. And in many cases the experience is very unpleasant.
“Necessity is the mother of all invention.”
What started out as filling a void for overcrowded emergency rooms and unavailable primary care physicians, urgent centers have been flourishing. It’s simple supply and demand. Supply of primary care doctors are dwindling and the demand for more convenient patient care is increasing. Now in any of your neighborhoods, you can get coffee, fast food and some “healthcare” rather quickly and merrily. 
I’ve gotten used to counseling my patients on the dangers of obesity and its association to fast food. Lately, I’ve had to start counseling my patients on the dangers of fast food medicine. Although I recognize their need and why they appeal to patients (consumers!?!), I have serious concerns about the impact Urgent Care centers have on healthcare at large. Just in the past few years, these are the types of issues I’ve noticed from care provided by such places.
Over prescription of antibiotics
Unnecessary use of broad antibiotics
Shot gun blood work with spurious findings
Recommendations to pursue unnecessary advanced imaging
Unnecessary recommendations to see specialists
Patient expectations for over treatment and extensive work ups

These are just broad generalizations but after a years, my patient sample size is growing.
I’m not a business man, but in the “for-profit” world” you do things that get you paid (x-rays, blood work?) and you give the consumer what they want to ensure return business. These are dangerous business concepts when applied to healthcare and urgent care centers are rapidly becoming the prime example of this. 
As the cost of our healthcare approaches 20% of our GDP and medical educators at all levels preach value and cost, urgent care centers, retail clinics and their profit incentives threaten to undermine this entire movement.

I’m not the only one that is worried about this.
The link below comes from a blog post on Kevinmd.com echoing similar sentiments. 

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A Wasteful Week

     I’m a bit of a backseat driver these days. As a result of the economy and the number of people who have lost insurance (and gained Medicaid) we’re seeing a lot of new patients who previously had commercial insurance plans and were being seen by community providers that do not accept Medicaid. Some of them reluctantly come to our resident clinic, but the majority are very grateful for the opportunity to receive excellent comprehensive care from our well intentioned trainees during a difficult transition in their lives.
I’ve never really worked as a private practitioner in the community, but this influx of patients switching to our clinic has given me some (albeit very limited) perspective on the care they receive in the community with commercial insurances. For the most part, everyone receives excellent care and they often express disappointment that they have to leave their long standing doctor. But on several instances, when we investigate their past medical histories, we’ve been seeing several instances of what appears to be wasteful unnecessary care.

In 1 week, here is a sampling of a few of these cases.

1: Middle aged gentlemen in good health, well controlled high blood pressure and some family history of heart disease was getting yearly stress tests because ” My doctor  was thorough and wanted to be sure.”

2: Gentleman who got his first colonoscopy at age 47 because according to his wife “We had really good insurance.”
 
3: Twenty something  year old female, with mild occasional anxiety was getting yearly EKG’s as part of her “Annual Exam.”
  
I know I’m looking at these cases as a backseat driver. Perhaps I was getting an incomplete history and there were good reasons why these tests were ordered. But my instincts, medical knowledge and perspective on our current healthcare system suggests it falls under the category of wasteful care.
Reuter’s Report on Healthcare system waste 2009

We are all guilty of practicing wasteful care and it’s a multi-factorial problem. It start’s by changing our mindset towards healthcare by looking at things in terms of value. We also need to make a concerted effort towards following the evidence, and when the evidence is overwhelming, use validated clinical decision support tools.

Case 1: See number 2. Choosing Wisely (American College of Cardiology)
Case 2: USPTF Colon Cancer screening guidelines
Case 3: Rethinking the value of the annual exam

We also have to hold each other accountable for these problems, and sometimes that means being an annoying backseat driver with a computer and a blog 🙂