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 2ndultrasound 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?