Despite Evidence, Patients Want More #healthcare #patient-education @myEn #In

The journal Health Affairs just surveyed more than 1,500 patients with employer-provided insurance, including dozens in focus groups and one-on-one interviews.

The “pervasive themes” from respondents, according to the authors, were “more is better, newer is better, you get what you pay for, (and) guidelines limit my doctor’s ability to provide me with the care I need and deserve.”

via npr.org

 

As I have stated over and over on this blog, true health care reform will encompass improving quality, increasing coverage and perhaps most important (to me) control health care costs. These issues are obviously not mutually exclusive. one can not be changed without controlling the others.   Many of the physicians I talk to feel that they have no incentive to control costs… they also feel that if they take the time, and make the effort to control costs via education,  that they will suffer financially.

As most of you know I am an orthopedist. Nearly everyone of the patients I see in the office will request or even insist upon an MRI, CT or even an X-ray. Most of these tests are simply not necessary…. and may in fact be *harmful*.   I order FAR fewer MRIs than many of my colleagues…. Does that mean the care I offer is any less advanced. Absolutely not!! The literature has proven over and over that we do not need to X-ray every ankle injury, or every low back strain— it has also shown that a quality physical examination by a well trained sports medicine doc will frequently lead to a more accurate diagnosis than an MRI will.

MRIs are useful in many circumstances. They are very useful to confirm a clinical suspicion when diagnosis isn’t clear and surgery might be necessary. They are not needed to tell someone they have an ankle sprain, a rotator cuff strain, low back strain, etc. Is there a good chance the MRI will alter your chosen clinical pathway? If the answer is yes, then an MRI is indicated. Should I MRI your knee if you injured it yesterday and the likelihood of spontaneous is high? Nope. What about someone with back pain after working in the garden all day… again, nope.  Most injuries follow easy to diagnose by a history and physical exam alone—and most injuries follow a benign course to resolution 

I need to spend quite a long time explaining to patients why an MRI isn’t necessary in their particular condition. Most will understand and go along with it. Some will not and will probably not be happy until they get their MRI (usually by another provider).

But this brings up an even more important topic. How many unnecessary MRIs are leading to unnecessary procedures?  Do you realize that a substantial number of “NORMAL”, assymptomatic individuals have meniscus (cartilage) tears in their knees, disc hernations in their neck and back, rotator cuff tears and labral tears in their shoulders? Now, suppose your mom or dad goes to the doc complaining of knee pain. Many docs will order an MRI. Based on their age they may have a high likelihood of having a tear (but most *degenerative* tears are not bothersome). So the MRI shows a tear and the patient is sent to an orthopedist who suggests surgery based on the MRI interpretation,  despite the fact that the patient has only had pain for a few days and despite the fact that they know many patients with degenerative tears will do very well without surgery. Some tears might require surgery, but that decision will based on much more than simply the MRI reading. So, many MRIs are leading to many unnecessary procedures further increasing the cost of care to the health care system. Physicians have an obligation to improve their patients understanding about a new technology and when the technology could be useful and when the technology might actually be harmful. We also have an obligation to utilize tests when clinically indicated and not simply because you do not want to have a 5 minute discussion with a patient. That time is well spent and can go a long way to diminishing the cost of health care delivery and improving a patients understanding of how the technology is useful.

Improving care, containing costs and educating patients is important to all of us… after all…

We are all patients !!!

 


This post is not meant as medical advice.  Whether or not imaging or other modalities are necessary to treat your condition is between you and your physician. 

 

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About hjluks

A busy Academic Orthopedic Surgeon, Digital Strategist, Chief Medical Officer and father... intently and efficiently navigating the intersection of Social Media and Health Care.
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7 Responses to Despite Evidence, Patients Want More #healthcare #patient-education @myEn #In

  1. Anonymous says:

    Very true. Patients come to the office with the following complaint: “I need an MRI”. Another example is a patient with low back pain of 1 week duration who, I found out later, went to another provider where he received an MRI and a lower extremity nerve conduction test. Both were negative. What a waste. I often tell my patient that I recommend an MRI only when surgical treatment is considered. That will deter them from insisting on getting an MRI.

  2. Howard Luks says:

    You must have had a few decent instructors 🙂

  3. Bryan Vartabedian says:

    More infuriating: Many children with any degree of abdominal pain (reflux, constipation) draw abdominal CTs in ERs. A disturbing trend and a sure sign that we’ve enabled technology to marginalize our role in patient care.

  4. Howard Luks says:

    Not too mention the long term effects of those scans on these poor kids. I just don’t buy the defensive medicine story. See the patient, examine the patient, document your findings (no scribe allowed!) and state why CT is NOT clinically indicated. Done! Very very very few jurors will ever have a problem with a caring doc who spend time with patient and came up with reasonable plan.

  5. Howard Luks says:

    NY Times piece on the treatment of “incidentalomas”. Unnecessary scans lead to unnecessary and occasionally complicated follow up tests and procedures. http://goo.gl/v41y

  6. Howard Luks says:

    Thanks for the comment Steve… the evidence is mounting. Over-utilization, over treatment, etc etc etc can be quite detrimental to our health. We ALL have a role in decrease such excesses. Patients and Providers alike.

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