The June 1 st edition of the New Yorker featured an article by Atul Gawande, a reporter who is also a physician and a professor at Harvard Medical School, entitled "The Cost Conundrum."
The article is available on the New Yorker website for your reading pleasure, but I'll give you the gist of it here.
According to the article the highest cost of health care, garnered from the records of Medicare payouts, is the county of Hidalgo in deep South Texas. His research on this piece centers on the city of McAllen and two of its hospitals, McAllen Medical Center and Doctors Hospital at Renaissance.
After spending a few days there Mr Gawande concludes that the reason that health care costs are twice as high is this- doctors ordering far more tests and procedures than is necessary. He focused on Doctors Hospital at Renaissance as it is physician owned.
I can't say that I entirely disagree with him. I can see where doctors who own a facility, even an imaging center or other diagnostic service, might be inclined or tempted to order expensive procedures and tests that are questionable as to being medically essential.
Problem is, a physician without scruples or morals can make out like a bandit.
But even honest doctors are stretched to the limit, over worked and exhausted, possibly making decisions with less than stellar information. I remember in my early years as a respiratory therapist seeing a doctor order breathing treatments after listening to the patients chest and hearing "expiratory wheezing," a common symptom of asthma.
Neither the patients nurse or I had the nerve to tell him that the ear pieces on his stethoscope were around his neck and not in his ears when he "heard" the wheezing. I have since grown bolder and am quite capable of informing a doctor of such a faux pas, and have paid the price for it. But, hearing "what medical school did YOU go to?" is worth being a patient advocate for.
Most doctors, though, will cut you off quick if you try to question an order. Some are so feared that automatic compliance is your only option. This is not good for the patients or the staff, which become a bunch of drones mindlessly going about their work without even a trickle of a thought about questioning a very questionable order. More's the pity.
I have personally seen and have heard of doctors ordering breathing treatments for their patients so they will be checked on "at least every four hours." This is in response to nursing staff having more patients to take care of than they can do so safely, and from respiratory therapists having very sick patients, including those with tracheostomies, on two or three floors.
I concluded years ago that each facility has a room deep within its walls, a room with no windows and a small tin fan squeaking away, trying to circulate stale air and dust. In this room is a pitiful man with a tiny brain, sitting at a broken down desk, scribbling on a legal pad.
What he is writing is, in my considered opinion, the crux of the reason for the rising cost of health care.
Rules and regulations and requirements and competencies and on and on and on.
What's wrong with that you ask? Shouldn't hospital staff be subjected to these kinds of things? Absolutely. The problem is, these people have no idea what they are doing because they have either never taken care of a sick patient or were so bad or dangerous that they were promoted out of the trenches.
Here is my proposal. I firmly believe that if hospitals took this advice patient care quality would skyrocket, costs would plummet, and they would have applicants lined up around the block trying to get a job with them instead of being dangerously understaffed.
Any person, from lower management to the CEO, of ANY facility, MUST have at least two years of health care experience and be required to maintain their professional license throughout their career. I mean, actual patient care- no more business school grads who have never had to stick a needle into a patient. This way, any rule or mandate placed on their staff would come from actual knowledge and would not conflict with other edicts.
They would be required to, themselves, use any piece of equipment that was being considered for purchase. This alone would reduce staff frustration by a minimum of 70%, thus improving patient care quality resulting in lower costs.
Sound crazy? Think about this.
Would the US have gone to war in Iraq if George W. Bush would have had to grab a weapon and hit the sand?
Ken McCreless is just a guy who loves to write. No dazzling website or publishing milestones, just a love for words and a respect for the power they wield. Contact him at ken@kenmccreless.com
» left by sue thom from nj (115 days 12 hours ago.)
hi ken,
very interesting.
my mom took a stand about 6 months before she passed, and she struggled with what she should do fiercely, and confided in me. it appeared a doctor that she knew and had worked with for years, wasn't up on the newest GI procedures, and my mom knew that cancer may not be detected because the tube was not extended far enough. finally, she talked to him about it, but to no avail. she reported him, and he was made to follow the procedure my mom knew was more thorough.
and he didn't hold a grudge, and actually apologized!
it's scary to think that if something happens to you physically, and you are taken to the hospital, there are many people and equipment that are incapable of doing their job well.
I can understand what your mom went through. Some doctors count on folks like her to help them do a better job, but, sadly, most do not give a squat what anyone thinks.
But what can I do? God gave me a voice for a reason.
Thank you for your great and continued support and encouragement. You may never know how much I need and appreciate it.
Great article. I work in a drug store, and the amount of pharmacy training I had to do (and still have to do as it is on-going) is mind-boggling. The reason is simple: to prevent the worst thing. That would be, a patient comes in for a prescription and gets the answer, "uh, I don't know." That is the nightmare scenario, and yet it happens all the time in countless pharmacies (hopefully not one of ours) and hospitals. You have hit on something many are unaware of. Good job, Ken.
What an excellent article, written by an "insider". I couldn't agree with you more.
Things look different to those in the trenches. It's clear to me you have some great ideas that, if implemented, could save time, money, patients and frustration all 'round.
I do believe my ideas could help turn the situation around, but a lot of egos would get stepped on. SO many say "the patient comes first," but that is only so much baloon juice.
Thank you so much, Grammy. I appreciate your taking the time to read and comment.
Hi Ken, what a dynamite article and I think you are right about anyone in a higher-ranking health-care position being required to have two-years' health-care experience and to maintain a license throughout their tenure ~ a little bit of House attitude in this, Ken, but I love it, and I applaud your transparency in exploiting issues that need to be brought to light.
On a personal level, I will not deny that I have a tendency towards being holistic but throughout the many years of relationship with my GP, he grew accustomed to my ways and believe learned something about it being possible to stay healthy without subjection to every type of treatment and/or medication. I on the other hand have also thanked my lucky stars for having such an understanding physician to put up with me ~ understanding works both ways in a doctor-patient relationship ~ being from a fairly big city makes this possible but those living in smaller towns do not have the same privileges I am certain.
Thanks for sharing and caring! I loved the article. Blessings! Suzy
p.s. oh, and I loved how you sealed the article with a comment about running off to war and Bush hitting the sand (one of my favorite expressions)....
You are indeed fortunate to have such a wonderful doc, Suzy. However, my heart goes out to a LOT of the patients that I see because of they way their doctor talks to them.
One night I thought I had stepped into the "Scarface" movie set. Some guy was talking to an old lady just like Manny, I think his name was, Pacino's sidekick in the show. Every other word was "ok?" The accent was the same, and the reaction of the patient was like someone being bossed around, not treated. The "guy" was her doctor!
Thank you for reading and commenting, always much appreciated.
BRAVO!!! Thanks for your input here, Ken. Yea. I've been 'absent' for a while..but I'm back...and yours was the first piece I read (of course). So good to 'see' you again! By the way, love the impact of that last question posed. NOFREAKIN'WAY would we be in the Middle East right now if George had been required to pick up a weapon. We ALL know that...too bad it doesn't (yet) work that way, huh?
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