Better Health: Smart Health Commentary Better Health (TM): smart health commentary

Article Comments (1)

Cutting Healthcare Costs Means Saying “No” To Patients

Let’s face it, the best way to cut healthcare costs is to say “no.” That means denying unnecessary tests that most patients in the United States are accustomed to having.

The New York Times‘ David Leonhardt has the best take on this issue that I’ve read. He acknowledges the difficulty of telling the American public “no,” and cites examples ranging from the breast cancer screening controversy to the managed care backlash in the 1990s:

This try-anything-and-everything instinct is ingrained in our culture, and it has some big benefits. But it also has big downsides, including the side effects and risks that come with unnecessary treatment. Consider that a recent study found that 15,000 people were projected to die eventually from the radiation they received from CT scans given in just a single year — and that there was “significant overuse” of such scans.

The economic arguments against overtesting simply won’t resonate with patients. Despite the dire forecasts of bankruptcy and Medicare insolvency, “the try-anything crowd occupies the moral high ground … Compared with an anecdote about a cancer patient looking for hope, the economic arguments are soulless.”

He proposes capitalizing on the uniquely American traits of free choice and more control instead. Give patients and doctors the necessary effectiveness data to make their own decisions on whether to undergo a test. Some studies even suggest that patients would err on the side of not testing once all the risks and benefits are known.

As for doctors, the malpractice system shouldn’t punish them for a shared decision that holds back testing, yet results in a poor outcome. Instead of advocating for malpractice caps, I agree with shielding doctors who follow clinical guidelines from liability.

Leonhardt says it will be very difficult to say “no” to the American “yes “culture. But if we can empower patients by providing the information to make their own informed decisions, perhaps we may not need to.

*This blog post was originally published at KevinMD.com*


You may also like these posts

Read comments »


One Response to “Cutting Healthcare Costs Means Saying “No” To Patients”

  1. soooo, i did previously participate in yu gi wow many
    years before. We’re ready to maneuver, and having a moving household kind of lawn sale. I have over 500 yu gi wow cards that i would want to get rid of. I have a bunch of rare types but i dont really care for them therefore i dont would like to work their way through the difficulties of researching these. Just how much do i need to charge to trade the cards?

Return to article »

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

Read more »

How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

Read more »

See all interviews »

Latest Cartoon

See all cartoons »

Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

Read more »

The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

Read more »

Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

Read more »

See all book reviews »