Medical Overdiagnosis and Overtreatment – Do Physicians Want Cost Control?

Truth is more absurd than fiction.  Mayor Michael Bloomberg’s wacky ban on certain sizes of sugary beverages, a scheme which was riddled with inconsistencies and exceptions, was properly squashed by a New York judge.  The mayor’s next play was to order all establishments that sell cigarettes to hide them from patrons.  I hope that this policy is examined in the same courtroom that ruled that the leaky soda ban was illegal.  Is this guy a mayor or an emperor?  Who can legitimately defend the government dictating to private businesses how they can display legal products to its customers?  Where would candy, potato chips and other poisonous snack foods be sequestered? 

 

Speaking of sequestration, which the president warned would crush the country, the earth still rotates, the sun rises in the morning and congress has a 15% approval rating.  In other words, not much has changed. 

We learned that there was not enough cash to fund White House tours for school kids.  Yet, we learned that Vice President Biden and his entourage spent $585,000 for a single night in a Paris hotel last month.  The VEEP & Co. were more frugal when they stayed in London on the same gig when the price tag for one night was a mere $459,000.  This seems a smidgen extravagant during such economically lean times and conveys a message of prodigal excess to the hoi polloi.   Is it possible that some of the expense for these 2 nights was excessive?  Was every government official on this junket essential to advance American interests?  While I don’t suggest that the VEEP stay in a Bed & Breakfast or a youth hostel, I’ll bet that these obscene hotel costs could have been reduced without jeopardizing our foreign policy interests.

 

$585,000 + $459,000 = Lots of White House Tours for Kids

 

 

I know from my own profession how many zillions of dollars are wasted that generate income for various constituencies but don’t advance the greater good.  I have admitted repeatedly that I and my colleagues are one of these constituencies.  While the phrase cutting waste is an attractive populistic utterance, the substitute phrase cutting income is more provocative.   Every dollar of waste is someone’s income who likely doesn’t view his earnings as wasteful spending.  Of course, this is not particular to the medical arena; it’s true of every profession, trade and institution.

 

I have railed in this blog about the explosion of unnecessary radiology testing in medicine.   CAT scans of the abdomen have largely replaced physicians’ examining abdomens, similar to how echocardiograms have replaced actual physicians discerning subtle heart sounds and murmurs with the antiquated medical instrument known as a stethoscope.   While those who overdiagnose and overtreat, including gastroenterologists, justify their practice patterns as sound medicine, watch these practice styles screech to a halt once punitive payment policies against medical overuse are implemented. 

 

This week I saw a patient with abdominal pain who had a normal ultrasound of the abdomen 2 days prior to hospitalization at another institution.  The dictated report was on the chart for all to review.  The attending physician had ordered a special gallbladder test, but the radiologist had insisted that an ultrasound be repeated first.   Did we expect that a 2^ndultrasound 48 hours later would show new findings?

 

I see this stuff every day and it is these observations that led to the creation of this blog.  There is waste in the care of every patient, including mine, but the system has been immobile and immutable.  The medical industrial complex is a lumbering ocean liner whose course extraordinarily difficult to alter.  Every real reform threatens powerful, highly motivated and well-funded players. 

 

Obamacare has smashed through the barricades and promised to be the panacea that eluded us for over half a century.  I have been a deep skeptic and my skepticism has deepened with time, along with the rest of the country.  Let’s watch what actually happens to medical costs and quality as the government rules and regulations coerce doctors, patients and employers.  When the myths of Obamacare are exposed, will the president come clean to our kids when they are finally allowed to visit the White House?