Wednesday, June 23, 2010

Another Example of Overuse

I have harped on the overuse of medical equipment, procedures and tests as a major cause for the high cost of health care in the U.S. in numerous blog posts. In addition, I have occasionally spoken to the fact that this excessive use is leading to harm in many instances in the patients we treat.

Although we hope that the greater acceptance of evidence-based medical and surgical protocols will start the decline of overuse, we know that this will take significant time and never be totally successful as long as physicians and other providers have full or partial ownership of the imaging technologies. Some providers will unfortunately permit the misalignment of the increased revenue from unnecessary procedures to drive their ordering practices. So what else might help? Of course, a greater involvement of the patient in determining the need for a specific procedure.

I recently saw an AP story carried in both the Wall Street Journal and The Dallas Morning News supporting my position. Speaking to the overuse of radiation in America, the author clearly articulates the negative consequences of too much radiation for any individual over his or her lifetime. Some authorities predict that in the next 10 years, two to 10 percent of cancers in the U.S. will be caused by excessive radiation—a truly sad outcome if any or all of these cases become true.

The author of this article, aware of the misalignment of incentives described above, listed nine questions that Fred Mettler, a radiation-safety expert, suggests every patient asks before getting a scan or other radiologic tests. Because I agree totally with him, I list them here:
• Is it truly needed? How will it change my care?
• Have you or another doctor done this test on me before?
• Are there alternatives like ultrasound or MRI?
• How many scans will be done? Could one or two be enough?
• Will the dose be adjusted for my gender, age and size? Will lead shields be used to keep radiation away from places it can do harm?
• Do you have a financial stake in the machines that will be used?
• Can I have a copy of the image and information on the dose?

It is my hope that through the combination of the use of evidence-based medical practices, the education of the public through similar articles, and the patient/family questions like those listed above, the overuse of medical and surgical treatments will be eliminated, thereby achieving our goal—high quality, low cost health and wellness care for all!


Anonymous said...

Thanks for posting those questions, Dr. Royer. Better patient education is instrumental in saving costs!!

Anca Adams
Houston System Support Center

Dr. Tom said...

Thanks for your comment, Anca! It is clear that we all must partner in the future with our patients, care providers, and suppliers if we are to reduce waste and overuse in our health system. Thank you for reading my blog!