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Overtreatment: When Less Is More In Medicine

The Associated Press recent article “Overtreated: More medical care isn’t always better” reiterated a commonly known fact which is not understood by the public. This problem of doing more and yet getting little in return is a common issue which plagues the U.S. healthcare system and was illustrated quite convincingly by Shannon Brownlee’s book. Americans get more procedures, interventions, imaging, and tests but aren’t any healthier.

In fact they are often worse off. Too many unnecessary back surgeries. Too many antibiotics for viral infections, which aren’t at all impacted by these anti-bacterial therapies. Too many heart stents which typically are best used when someone is actually having a heart attack. Research shows that those that are treated with medications do just as well. As all patients with cardiac stents know, they also need to be on the same medications as well.

Eliminating unnecessary treatments is a good thing, particularly when it is based on science. Read more »

*This blog post was originally published at Saving Money and Surviving the Healthcare Crisis*

“Heart Strings”

Thanks to the wonders of magnetic resonance imaging (MRI), amazing images of “heart strings” — the muscle fiber orientation of the left ventricle of the heart — have been obtained. According to the University of Oxford:

The image was produced using a branch of magnetic resonance imaging (MRI) called diffusion tensor imaging (DTI). The technique tracks the diffusion of water throughout the myocardium (the heart’s muscular wall comprising interconnected sheets of muscle cells called myocytes). Due to the way the myocytes are organized, the movement of water is restricted, so tracking the location of water molecules can reveal valuable information about the structure of the heart in a non-invasive way.

Nice.

-WesMusings of a cardiologist and cardiac electrophysiologist.

*This blog post was originally published at Dr. Wes*

Until Patient Behaviors Change, “I Do The Damn Test”

Congress controls the nation’s purse strings. It can tell the Executive Branch how to spend money. It can regulate all commerce, and by the way, to Congress everything is “commerce.”

Congressional legislation can incent economic behavior–pay for this, but not for that–but it can’t change personal decisions. A case in point is Dr. Robert Cantor, ACP Member, of Boca Raton, Fla., who says he authorizes the tests that his patients demand. His opinion? “I do the damn test.”

He says there’s little incentive not to order tests and little in healthcare reform to make him and others change their habits. More likely is the idea that, once new medical technology is invented, it will find a use.

Another article compiles a wide spectrum of ideas on how to reduce healthcare spending. Tort reform was one, sure, but many doctors focused on changing patient behavior first.

*This blog post was originally published at ACP Internist*

How CTs and MRIs Drive The Cost Of Healthcare

It’s well known that the use of imaging scans, like CTs, MRIs and PET scans, have been growing at an alarming rate. But a recent study provides some stark numbers. According to a recent CDC report, “MRI, CT or PET scans were done or ordered in 14 percent of ER visits in 2007.” That’s four times as often as in 1996. Although a physician called that growth “astounding,” it’s really no surprise.

Emergency departments are becoming more crowded, and with patient satisfaction scores becoming more influential in financial incentives for physicians, sometimes just ordering a test is the path of least resistance. Factor in the spector of defensive medicine which, according to a survey from the Massachusetts Medical Society, accounts for up to 28 percent of tests ordered, it’s a wonder that more scans weren’t ordered.

Imaging scans are a clear cost driver in healthcare, contributing $12 billion to Medicare’s bill. But costs won’t resonate with patients requesting the tests or the doctors ordering them. One encouraging sign is the recent trend of publicizing the harms of scans, like radiation from CTs. I’m finding that patients are becoming increasingly aware of the risk, and making a more informed decision after I explain it to them. It’s a small step forward.

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

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…

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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…

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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…

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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…

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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…

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