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NEJM Publishes Proposal To Minimize Spending In Oncology

Recently the NEJM ran a Sounding Board piece on Bending the Cost Curve in Cancer Care. The author’s take on this problem:

Annual direct costs for cancer care are projected to rise — from $104 billion in 2006 to over $173 billion in 2020 and beyond.2…Medical oncologists directly or indirectly control or influence the majority of cancer care costs, including the use and choice of drugs, the types of supportive care, the frequency of imaging, and the number and extent of hospitalizations…

The article responds, in part, to Dr. Howard Brody’s 2010 proposal that each medical specialty society find five ways to reduce waste in health care. The authors, from the Divisions of Hematology-Oncology and Palliative Care at Virginia Commonwealth University in Richmond VA, offer two lists:

Suggested Changes in Oncologists’ Behavior (from the paper, verbatim — Table 1): Read more »

*This blog post was originally published at Medical Lessons*

More Medical Waste: Does A $6000 Flashlight Improve Patient Outcomes?

So I’m rounding in the ICU the other day when I came upon this new hospital medical device.  It’s called a pupillometer.  What does this pupillometer do?  It  measures subtle changes in the light reflex of the pupil to help take the physical exam to the next level of precision.

Or eliminate it, depending on how you look at it.  What used to be a basic physical exam skill is now being replaced by a $6000 piece of medical technology that can distinguish tiny changes in pupil size. Now the real questions remain.  Has this pupillometer device gone through the rigors of randomized trials in the ICU to define whether a  $6000 flashlight changes outcomes or mortality?   And if not, how do we allow medications to require such testing but not the technology that often changes nothing and simply makes health care more expensive.

The way I see things, if I’m trying to decide whether someone’s pupils constrict 1% vs 3% vs 10%, I’m getting a palliative care consult instead and putting the pupillometer back in my holster.

First the vein light.  Now the pupillomter.   And I thought the super bright LED pen light was all the rage.

*This blog post was originally published at The Happy Hospitalist*

Should Elderly Men Be Screened For Prostate Cancer?

A study in the Journal of Clinical Oncology found that “that men in their seventies had prostate cancer screening nearly twice as often as men in their early fifties, who are more likely to benefit from prostate cancer detection and treatment.” An American Society for Clinical Oncology news release includes this quote:

“Our findings show a high rate of elderly and sometimes ill men being inappropriately screened for prostate cancer. We’re concerned these screenings may prompt cancer treatment among elderly men who ultimately have a very low likelihood of benefitting the patient and paradoxically can cause more harm than good,” said senior author Scott Eggener, MD, assistant professor of surgery at the University of Chicago. “We were also surprised to find that nearly three-quarters of men in their fifties were not screened within the past year. These results emphasize the need for greater physician interaction and conversations about the merits and limitations of prostate cancer screening for men of all ages.”

The US Preventive Services Task Force states that the current evidence is insufficient to assess the balance of benefits and harms of prostate cancer screening in men younger than age 75 years, and it recommends against screening for prostate cancer in men age 75 years or older.

*This blog post was originally published at Gary Schwitzer's HealthNewsReview Blog*

Can Patients Commit Medicaid Fraud?

We hear so much about health care fraud and how much it costs us all in terms of higher Medicaid, Medicare and private insurance costs, and if we could just rein in this fraud we could make our health care system pay for itself.

My trusty Mac widget dictionary defines fraud as:

  • a person or thing intended to deceive others, typically by unjustifiably claiming or being credited with accomplishments or qualities and
  • wrongful or criminal deception intended to result in financial or personal gain.

Well, I’m wondering, what is actually considered fraud?

Let me give some examples, and help me understand whether or not this is fraudulent behavior. The examples are purely hypothetical and do not represent any known individuals, living or dead, or specific situations in any known emergency department, living or dead. Read more »

*This blog post was originally published at Emergiblog*

Waste In The Healthcare System: An Allegory

AUTHOR’S NOTE: I am very frustrated with a system that increases cost dramatically and yet reduces what I get paid. The rest of the money is going somewhere, and since it is not improving the overall quality of care, it is mostly waste. We are enamored with MRI scans, stents, and expensive cancer treatments, with little to show for them except increased expenses and a lot of third parties getting rich off of this waste: drug and device manufacturers, medical imaging companies and other para-healthcare industries. This story, which originally appeared at Musings of Distractible Mind, is prompted by my frustration with waste and how it spurs unneeded health care delivery.

Once upon a time there was a land on the ocean. The people lived off of the food from the ocean and were very happy. But as they grew bigger, they had a problem: They made a lot of waste! Yuk! Nobody likes waste. What could they do about all of this that stuff that nobody needed? Read more »

*This blog post was originally published at ACP Internist*

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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