Healthcare industry must empower patients to say no to unnecessary care
Healthcare journalism has morphed away from the standard articles about the new hospital CEO and breakthroughs in cancer research. Recent articles focus on the absurdity of our care delivery system.
Steven Brill broke open the commodification of healthcare two years ago to the wider public with "Bitter Pill" in Time magazine. Slightly more low profile has been Atul Gawande, M.D., the surgeon at Brigham & Women's Hospital who moonlights as a writer for New Yorker magazine.
Brill's coverage of healthcare is affixed with dollar signs. He talks about aspirin that costs $10 a pop or hospitals that hold cancer patients hostage for their credit cards. Gawande explores the mechanistic side of healthcare delivery. The most memorable image he has conjured has been the cardiac surgeon in rural Texas who has cracked open the chests of more than 8,000 patients--a feat that leaves Gawande winded when he thinks about it.
Gawande has revisited this mechanistic feature of healthcare in his most recent New Yorker article, "Overkill." There, he delves into great detail about the millions of unnecessary tests and procedures that are performed in this country every year and how they sap the pocketbooks of everyday Americans. The article is peppered with discomfiting facts: MRIs that can cost $1,000 or more are tossed around like Hershey kisses; cardiac catheterizations are performed as precautionary measures even when they are not part of the standard of care; and a patient who insists on undergoing the removal of her thyroid even though the risks of surgery outweigh the risks of the tiny cancerous nodule on the gland.
The most horrifying story involves an 82-year-old family friend, who underwent triple bypass surgery because he had fainting spells. The father deferred to his son Bruce's judgment about whether to proceed.
"The blockages weren't causing his father's fainting episodes or any other impairments to his life. The operation would not make him feel better. Instead, 'success' to the doctors meant reducing his future risk of a stroke. How long would it take for the future benefit to outweigh the immediate risk of surgery? The doctors didn't say, but carotid surgery in a patient like Bruce's father reduces stroke risk by about one percentage point per year."
In other words, a mechanistic evaluation and solution. Bruce's father didn't fit the definition of success. He suffered a stroke on the operating table.
Merge healthcare's commodification with its mechanization, and you have its system of delivery in a nutshell
Brill and Gawande have proposed their own solutions. The former wants to make hospital systems bigger and more powerful but regulated to some degree. Gawande has proposed making hospitals more like The Cheesecake Factory, which is a mechanistic method for delivering mid-level restaurant meals.
Will this merger ever be broken up? Maybe. The Affordable Care Act (ACA) has had some success in reducing costs, and an accountable care organization introduced to the McAllen, Texas region--which Gawande profiled as having the most expensive care in the U.S.--has succeeded in cutting costs significantly.
But unless patients are empowered to put their foots down and say "enough"--the systematic changes required to actually make a dent in the way healthcare is delivered and financed will never occur. Unfortunately, patients are often still too cowed by the complexity of the services being delivered, intimidated by the reality of their own medical condition or that of their family member, and worried about the costs to insist upon hearing alternatives.