I came across this article (http://opinionator.blogs.nytimes.com/2012/05/27/in-medicine-falling-for-fake-innovation/?ref=health ) written by one of the faculty at UPenn. In this article he discusses how a new technology, the daVinci Surgical Robot system, while an innovative and cutting edge technology, has increased heatlhcare costs but does not seem to have a corresponding significant improvement in patient care or reduction in health care costs. In fact, there seems to be some evidence that for certain procedures, prostate cancer surgery, this new technology may increase complications. This commentary raises a very interesting point about healthcare: Why do Doctors always have to do something to a patient?
Why do Doctor’s always have to do something to a patient? What does that mean? Aren’t Doctors suppose to “treat” patients? Aren’t Doctors suppose to do something? Prescribe a pill?, Order a CT scan?, Draw lab work? There seems to be have developed, an expectation over the past few years, that physicians must do something: order the newest test, use the newest medication, utilize the latest high tech surgical tool. Obviously newer is better. Or is it? Part of this belief that newer is better is ingrained in physician training and what the expectation of treatment is: we see a patient, make a diagnosis and then we must order a test, prescribe a medication, do a procedure. We must do something or we are a bad Doctor. Compounding this issue is that throughout training physicians are taught all the latest innovations. One becomes a “superstar” in training by quoting the latest research paper, utilizing the latest lab test or newest medication to treat a patient. The perception is the doing something is always better and the best physicians are always adopting the latest medication or technology first. But is this the best approach to medical care?
Healthcare organizations are just are culpable for perpetuating this myth. How many times have you seen ads that tout we are the first to offer fill in the blank technology? We are the only organization in the area that has fill in the blank technology? These ads are very effective. The goal is to “get” more patients to come to the sponsor of the advertisement. The problem as highlighted above is that all this new technology may not improve healthcare. The sad fact is that advertising that “Our Doctors and our organization will do less to improve your health and reduce your healthcare costs” does not advertise well.
Patients also have a role to play. Patients will often say to their physicians something to the effect of “are there any new medications or procedures out there for treatment”. Or patients will have the expectation, that a physician who offers the “newest cutting edge treatment” or the institution that offer the “latest surgical approach” are the “best” and have the best outcomes. Using a generic pill that costs pennies to treat hypertension must not be as good as the latest blood pressure pill that the insurance company will not cover. No longer does it seem acceptable to adopt a “watch and wait” approach. Nor does it seem acceptable not to perform any testing or procedure if they are not warranted. Patients want more testing, more medications more more more. But there is very little thought given to the concept that less is better, older cheap medications may work just as well and the newer and more expensive medicine or technologic breakthrough does not necessarily mean better health or cheaper costs. Given the current state of healthcare in the US, this is a very troubling development.
This problem is not something new. It has been around for years. But given the limited resources that are available for healthcare and the economic realities of today it has become more pointed. The question that needs to be asked, is what is going to improve a patients health, societies health and reduce healthcare costs. Physicians need to understand and adopt not what is the latest and greatest but what is the most effective and most cost effective treatment for their patients. Healthcare organizations need to ask what is going to improve the healthcare of their community not what is the slickest ad, about the latest technology, that can be run to improve the bottom line. Patients need to understand that doing nothing is sometimes better than doing something, newer is not always better and more expensive does not mean better outcomes or better care.
(As a footnote, this article was published just as I finished this blog http://www.ama-assn.org/amednews/2012/07/30/prse0801.htm )