We have to make tough decisions
Tuesday, March 26, 2013 10:00 PM
I'm writing this as we're getting closer to the implementation of all the facets of the Patient Protection and Affordable Care Act (Obamacare). No matter whether or not you support the ACA, the underlying impetus for the law remains -- the health care system in our country is in serious need of an overhaul. I want to focus on one area of medical care that is addressed in the ACA, the requirement that medical treatments are to be studied thoroughly and will be based on the best scientific and medical evidence available.
The math is inescapable; our country can't continue to face projected rising health care costs, particularly as the Baby Boomers enter their senior years and put a huge strain on Medicare. In addition to an aging population, expensive medical technology is advancing much more rapidly than our ability to pay for it.
It is unfortunate, but as a country we can't escape the fact that we need to start making tough decisions now to prevent economic collapse under the weight of rising health care costs. To do that, we need to tackle the problem as objectively as possible. It's difficult to keep the big picture of the health of our nation in focus when making individual health care decisions for ourselves, but it is critical to our economic survival.
The day-to-day practice of medicine often does not lend itself to objectivity. When it's your grandma or a patient you've taken care of for 30 years dying in the intensive care unit, it's difficult to look at things objectively and realize when it's time to let nature take its course.
There are certainly ways to reduce the cost of providing medical care without reducing its quality. The ACA has addressed most of these as well. It does much to provide for preventative care -- spend a few dollars now to save many more later. Medical errors and duplication result in worsened health and waste. Electronic health records (EHR) promise to help prevent medical errors and to allow medical providers to share information to coordinate care and reduce duplication of services.
We often hear the term "quality" during discussions of health care. This seems to be a simple term defined as improvement in health divided by cost. In medicine, the reality is it is not simple at all. One person's view of quality can be much different than another's. Americans in general have developed a skewed sense of what constitutes quality health care. We tend to expect to receive immediately what we want, when we want it -- a main ingredient in the recipe for disaster that has resulted in many of our current health care problems.
This is where evidence-based medicine comes into play and why it is addressed extensively in the ACA. Human brains are not wired to be able to make conclusions about our natural world through simple observation. We think we "know" things that in reality are often far from the truth. In science & medicine, we formulate hypotheses and test them through collection and analysis of data.
Some people find this methodology cold when applied to the care of human beings, but it is the best way we have to deliver medical care that makes a difference in outcomes, and hopefully in the most cost-efficient manner. This has been the impetus behind the "Choosing Wisely®" initiative, www.choosingwisely.org.
Evidence-based medicine can be frustrating when it results in recommendations that seem to change frequently, and may even conflict with current medical dogma and expert opinion. Recommendations for breast cancer screening and PSA testing for prostate cancer are two of the most recent well-publicized examples of recommendations resulting from evidence-based medicine that have stirred up hornet nests.
This is how science works -- we are constantly updating our view of the world based on the best available data at the time that may indeed result in turning what we thought we knew on its head. It's a messy business, but the only reliable method we have to avoid bias and get as close to the truth as possible.
We waste a lot of time and resources on medical treatments and alternative therapies that provide little or no benefit to our health. As a nation, we have to be open to educating ourselves and accepting science-based medicine as the most objective method we have to improve the health of our nation.
Dr. John Roberts is a family physician. He is also one of the owners of The Paper of Montgomery County. Send him your question today by e-mail at firstname.lastname@example.org.