Making sense of medicine

Don't be fooled; the health care in this country is NOT the best in the world. We may have more technology, fancier gadgets to do our surgeries for us, more expensive materials in our prosthetic devices. But our life expectancy is not the highest in the world. Our neonatal mortality rates are far from the best. Unwanted pregnancies cost us millions, even billions, in added costs - from poor birth outcomes to family violence, psychiatric problems, substance abuse, delinquincy. We die of obesity and cardiac disease at higher rates than anywhere else in the world. And we pay more than anywhere else in the world for the privilege.

Medicine doesn't make a lot of sense these days.  Patients are bombarded with information from all kinds of sources, and figuring out which are credible and which are not is a daunting task.  Physicians are also bombarded with information, just as their patients are, including pharmaceutical advertising, device manufacturers, well meaning patients, and the anecdotes they witness through the care of individual patients.. 

If they want to practice with integrity, physicians and other providers must find their own sources of education, take the time away from patient care to study and read and research in order to keep updated on the latest information.  They must be honest about the frequency of disease and the effectiveness of treatments, and objective about each individual patient.  Objectivity can be difficult to maintain in such an emotionally charged field as medicine.

  The cost of medicine is frequently secondary in the thought processes of physicians.  For the sake of expediency, they often prescribe the newest, most expensive medications because they have samples or because they honestly believe they are better, and not because they really understand how these medications compare to others on the market in terms of cost and effectiveness.  Primary care physicians make referrals to specialists sometimes because specialist care is needed.  More often, though, the referrals are made to speed patient flow in their office, to avoid having to take the time to research a medical problem, or because the physician honestly doesn't know how to proceed and can't afford the time to figure it out. 

It takes time for a physcian to practice thoughtfully.  And in our American world, money talks.  The patients with insurance get appointments.  The more appointments the more money.  The shorter the appointments, the more that can be scheduled.  Patients without insurance, or without the right insurance, can go elsewhere.  Or nowhere.

In my work, I advise primary care physicians and midlevel providers on how to manage the patients' medical problems in a cost effective way.  I research the problems when they cannot (or will not) and recommend management - treatment and/or testing that is supported by the medical evidence and that is cost effective.  I don't know everything there is to know.  But I do know how to find out many of the answers and how not to waste money.    And that is a start.