Thursday, May 30, 2013

Expensive Medical Decisions are Increasing Along with Overuse of Unnecessary Care

A quandary that I sometimes notice as a Family Physician is the paradox between the flawed brain and the loving heart.  Which one leads?  Which one follows?  Which one may lie to patient or doctor?  Which one seeks to protect?

The brain uses flawed decision processes to allow exploration of a limited amount of biased information to come to conclusions.  Can it be trained to develop better protective mechanisms against unnecessary, overused, low yield, expensive and sometimes harmful medical tests or therapies?

Can a patient brain register a strong decision rule about medical waste?  Who will give the patient the rule or help them to develop the decision rule?

OK, I'm getting troubled by the massive waste in our flawed medical system.  A patient  wakes up and complains to the nurse in his new assisted living that he has a headache.  She checks his blood pressure.  It's elevated.  He feels woozy.  She calls the paramedics.  They take him to the local emergency department.  BP is still up, otherwise he has a normal physical exam.  He gets a CT scan of his head, EKG, Lab Studies for heart attack, kidneys, CBC, urinalysis, and Chest XRay.

He had the same tests 2 months earlier when he got nervous before eye surgery and the eye doctor insisted that he go to the ED.  The eye Dr didn't call his Family Physician who would have seen the man the same day and resolved the problem.  Charge to Medicare: about $18,000 for emergency care and overnight observation.

The patient notes that he didn't get to take his blood pressure medicine before the squad brought him to the ED.  He is given his BP med- one pill.  In 30 minutes, he feels fine.  Headache is gone.  BP is normal again.  He goes home.

Estimated charge: $6000 to Medicare.

If he or the nurse at the assisted living had called his Family Physician, he would have received his blood pressure med and had the BP rechecked in a half hour.  Charge $0.

The Family Physician knew of two other instances with the same patient, over 90 years old, in which his BP jumped and came back down with conservative measures through the family physician's office.  Cutting out the Family Physician is one way to bankrupt America with medical charges.  If you follow the money, you'll notice how the system maximizes charges, not health or health care.

Who can be trained to have a brain that acts more toward reasonable use of the scarce, valuable resources in our health care system?  Almost all of the over 90 patients don't want "machines" to keep them alive and have a living will.  Some have the official Ohio DNR Form and have heard numerous times to call our office 24/7 if they have a problem, so we can protect them against the excessive use of medical services that is an epidemic in America.

We all have to get together over and over to fix some of this overuse and under care.
Our hearts are supposed to help our brains to balance difficult decisions.  Can we do better?

1 comment:

  1. Thank you for a valuable and to the point message. It is helpful to have some of the "hidden" Medicare costs revealed.