Quit Wasting My Healthcare

Comparative-Effectiveness Studies, Obama and High-Quality Care Now

In the Sunday Magazine section of the New York Times this past weekend (http://www.nytimes.com/2009/05/03/magazine/03Obama-t.html?_r=1&scp=1&sq=after%20the%20great%20recession&st=cse) there is an interview with President Obama on a range of subjects including healthcare. In the article, Mr. Obama says, “So when Peter Orszag and I talk about the importance of using comparative-effectiveness studies as a way of reining in costs, that’s not an attempt to micromanage the doctor-patient relationship.”

My argument to this point is that rather than sponsoring comparative-effectiveness studies, there are quite a few medical situations where there is a combination of scientific evidence and expert concensus by physician societies on more cost-effective ways of delivering quality care. BUT, those cost-effect, high-quality ways are NOT IMPLEMENTED. The greatest short-term opportunity lies in the effective implementation of the existing best-practices. The old proverb says, “To know and not do is to not know.”

As an example, a very large cost-component for employers and Medicare alike is acute low back strain. The evidence and guidelines point to pain management and physical therapy for a period of several weeks prior to imaging in the absence of several “red flag” signs and symptoms. The majority of patients spontaneously recover without further intervention. BUT, the physician recommends and the patient receives the $2,000 MRI anyway.

Mr. Obama points out that there is “informational asymetry” between the doctor and the patient, but my own personal bias is that the patient then needs an advocate to support them and counter-balance that asymetry. Give the patient more information about back pain, physical therapy, medication options, imaging options and surgical options. Give the patient more cost information that is directly translated into what it costs them out-of-pocket. Work with the doctor, not against the doctor. Support true collaberation between the patient and the physician in shared decision making.

“Absolute power corrupts absolutely,” said British historian Lord Acton. I’m a doctor and even I don’t want doctors holding all the decision making power.

Perform comparative-effectiveness studies and the losers in that game will work day and night to discredit the studies the people who perform them. Support and advocate for the patient where the rubber-hits the road and you will get better care for lest cost.