Op-Ed

Patients dissatisfied with unnecessary, expensive care

The results of the recent poll conducted by the Harvard School of Public Health and the Robert Wood Johnson Foundation about patient satisfaction with the U.S. health care system were, unfortunately, not surprising.

Nearly half of patients felt there are serious problems with quality and about three-fourths felt there are serious problems with the cost of health care.

What is causing such great patient dissatisfaction in a country that truthfully boasts ownership of some of the best hospitals, physicians and research institutions in the world? To put it simply, all too often the wrong care is given at way too high a cost.

A recent study in the American Journal of Preventive Medicine found that recommended preventive care was given only a little over half of the time during periodic health examinations, mirroring the findings in a 2003 report in the New England Journal of Medicine dealing with acute and chronic medical conditions.

At the 2012 Care Innovations Summit, one health care system was described as giving 15 percent of cancer patients the wrong diagnosis, and in almost a third of the patients, the treatment did not follow evidence-based guidelines. An additional 45 percent of the patients did not follow the recommended care.

One can envision a scenario where there is almost a 50 percent chance of a patient being given the wrong advice and a 50 percent chance of the patient following the advice. Who could blame the patient? However, I doubt the two groups would be the same.

Moreover, some patients are so tired of the current health care system that they are opting for alternatives. One patient illustrated this point by asking his doctor if bee honey could treat his arthritis. His doctor quickly suggested that the patient make an appointment for a full evaluation and treatment recommendations.

The variability in the amount of ordered medical tests and procedures is also disconcerting, as it has inflated health care costs and exposed some patients to unnecessary care. Medicare service use varies over twofold between different regions of the country, differences that cannot be explained by differences in patient illnesses.

Nationwide, the use of CT scans has increased threefold since 1993 and is estimated to cause 29,000 future cancers from scans taken every year. Even among doctors in the same emergency room, the use of imaging studies can vary twofold to threefold. Similar concerns exist regarding many other types of tests and procedures.

Excuses centering on defensive medicine and demanding patients do not hold water. Physicians are highly paid licensed professionals, and the buck stops with them.

Large differences also exist in Kentucky.

Recently, the Commonwealth Fund reported that in Covington, only 61 percent of patients with diabetes received effective tests to manage their disease. In Lexington, this number shrinks to 34 percent.

Data from Medicare has shown a substantial difference in the number of total knee replacements between the Louisville and Lexington health care referral regions. According to the Dartmouth Institute, from 2005 to 2006, six out of every 1,000 Medicare recipients in Lexington received a knee replacement. The rate was 43 percent higher in Louisville. These rates had grown more than 50 percent in five years.

Another pressing problem is the very high Caesarean birth rate at some Kentucky hospitals. The highest hospital rate for 2010 was 70 percent while the lowest was 21 percent. Both hospitals are in rural Appalachia.

Loss of credibility is becoming a major problem not only in providers that give advice but also in the research on which the advice is based.

Glenn Begley, the former head of global research at Amgen, was unable to duplicate the results of the vast majority of landmark studies (47 out of 53) that are used to guide the development of new drugs. This is one reason the Food and Drug Administration all too often approves and then withdraws approval for new drugs after they have been prescribed to an unsuspecting patient population.

And ghost authorship has been reported in almost 12 percent of research publications. The erosion in research integrity is so alarming that the Union of Concerned Scientists recently published an extensive report on the various methods used by industry to unduly influence medical research.

These problems not only expose patients to wrong, unnecessary and sometimes harmful care, but also have a much larger and deeper impact that negatively affects society and causes advice for needed care to go unheeded.

We doubt the patient who was taking bee honey heeded his doctor's advice to see him in his office, because before they parted, the patient stated, "Well I don't know about that, but one thing I do know is that I won't go broke taking honey."

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