A Wasteful Week

     I'm a bit of a backseat driver these days. As a result of the economy and the number of people who have lost insurance (and gained Medicaid) we're seeing a lot of new patients who previously had commercial insurance plans and were being seen by community providers that do not accept Medicaid. Some of them reluctantly come to our resident clinic, but the majority are very grateful for the opportunity to receive excellent comprehensive care from our well intentioned trainees during a difficult transition in their lives.
I've never really worked as a private practitioner in the community, but this influx of patients switching to our clinic has given me some (albeit very limited) perspective on the care they receive in the community with commercial insurances. For the most part, everyone receives excellent care and they often express disappointment that they have to leave their long standing doctor. But on several instances, when we investigate their past medical histories, we've been seeing several instances of what appears to be wasteful unnecessary care.

In 1 week, here is a sampling of a few of these cases.

1: Middle aged gentlemen in good health, well controlled high blood pressure and some family history of heart disease was getting yearly stress tests because " My doctor  was thorough and wanted to be sure."

2: Gentleman who got his first colonoscopy at age 47 because according to his wife "We had really good insurance."
 
3: Twenty something  year old female, with mild occasional anxiety was getting yearly EKG's as part of her "Annual Exam."
  
I know I'm looking at these cases as a backseat driver. Perhaps I was getting an incomplete history and there were good reasons why these tests were ordered. But my instincts, medical knowledge and perspective on our current healthcare system suggests it falls under the category of wasteful care.
Reuter's Report on Healthcare system waste 2009

We are all guilty of practicing wasteful care and it's a multi-factorial problem. It start's by changing our mindset towards healthcare by looking at things in terms of value. We also need to make a concerted effort towards following the evidence, and when the evidence is overwhelming, use validated clinical decision support tools.

Case 1: See number 2. Choosing Wisely (American College of Cardiology)
Case 2: USPTF Colon Cancer screening guidelines
Case 3: Rethinking the value of the annual exam

We also have to hold each other accountable for these problems, and sometimes that means being an annoying backseat driver with a computer and a blog :-)