The Sunday New York Times is chuck full of great information which I read weekly – especially since the Wall Street Journal doesn’t publish on Sundays.
There were three items on health which I found fascinating. The first was an editorial on how some hospitals around the country are cutting their costs and IMPROVING patient outcomes as the same time.
The second brought the health issue to closer to us, suggesting we take a serious look at why the U.S. is the only country in the world where annual physicals are the routine.
The third looks at salt and how conventional wisdom of eating less salt could do more harm than good.
The first two stories are not only related to health, but they are important economic stories because we spend more than any country in the world on health and on average we have worse patient results than most other industrial countries.
Part of the story of course is that many doctors and specialists have a conflict of interest when it comes to medical tests. They more they order the more money they earn from insurance companies. Of course those who don’t have insurance and can’t afford these medical tests don’t have access to the important ones that can save their lives.
Dr. Elisabeth Rosenthal, an MD and a NY Times writer, made the case that annual physicals are great for doctors’ income but not so much for patients.
Her key point is too much resource is put into physicals because they generate useless tests which can harm patients more than help.
How does that happen?
Many of the screening tests like for prostate cancer result in false positives, which frequently lead to biopsies and surgeries. But she notes, most men diagnosed with prostate cancer will not die from it and those who receive treatment can die from the treatment or be incontinent.
Other examples from her:
“Routine EKGs? No use.
“Yearly Pap smears? Nope. (Every three years.)”
“So why do Americans, nearly alone on the planet, remain so devoted to the ritual physical exam and to all of these tests, and why do so many doctors continue to provide them? Indeed, the last decade has seen a boom in what hospitals and health care companies call “executive physicals” — batteries of screening exams for apparently healthy people, purporting to ferret out hidden disease with the zeal of Homeland Security officers searching for terrorists.”
“There’s a lot of inertia and unwillingness to let things go — it’s hard for doctors and patients,” said Alan Brett, professor of clinical internal medicine at the University of South Carolina, who tells well patients there is no need to see him annually. “I’ve rolled back the frequency and intensity of screening over the years, absolutely. I’m not doing lots of things now, because there’s no evidence that they help.”
Instead she recommends regular testing for diseases which can kill you and for which there are cures – like colon cancer.
The second one was a NY Times opinion piece focusing on leading edge hospitals that improve results and cut costs:
¶In Seattle, the Virginia Mason Medical Center, once deemed a high-cost provider, has conducted rigorous internal reviews to eliminate waste and inefficiency. It says that after doctors were required to click through a computerized checklist of the medical circumstances needed to justify a costly imaging test, CT scans for sinus conditions dropped by 27 percent and M.R.I.’s for headaches by 23 percent. It placed nursing teams and supplies closer to patients, freeing nurses to spend 90 percent of their time on direct patient care, far more than the 35 percent at most hospitals. The time needed to process insurance claims was sharply cut by consolidating steps. In a tough environment for hospitals, Virginia Mason has been reporting margins of 4 to 5 percent.
¶The Cincinnati Children’s Hospital Medical Center is using computer models to predict the number of intensive-care beds needed for patients having surgery. When necessary, it limits elective surgeries that require access to the intensive-care unit, and the smoother flow of patients has allowed the hospital to avoid $100 million in capital costs to build new bed capacity.
¶Premier Inc., an alliance of more than 2,600 hospitals across the country, has been testing ways to save money and improve care. It stresses quick treatment to prevent deaths and costly complications from infections, strokes and cardiac crises. It has reduced unnecessary laboratory and screening tests. And it has reduced labor costs by eliminating inefficient processes, like multiple re-entries of the same patient data for admitting, scheduling, discharge and billing, and by using caseworkers or administrative assistants rather than nurses to call patients to remind them of appointments or checkups.
The last article by science writer Gary Taubes raises serious questions about salt being blamed for health issues. His research of studies show that not enough salt could be even more dangerous than too much salt.
“The idea that eating less salt can worsen health outcomes may sound bizarre, but it also has biological plausibility and is celebrating its 40th anniversary this year, too. A 1972 paper in The New England Journal of Medicine reported that the less salt people ate, the higher their levels of a substance secreted by the kidneys, called renin, which set off a physiological cascade of events that seemed to end with an increased risk of heart disease. In this scenario: eat less salt, secrete more renin, get heart disease, die prematurely.
“With nearly everyone focused on the supposed benefits of salt restriction, little research was done to look at the potential dangers. But four years ago, Italian researchers began publishing the results from a series of clinical trials, all of which reported that, among patients with heart failure, reducing salt consumption increased the risk of death.”
I encourage everyone to read both articles.
