BOSTON—You may have read about a Maryland cardiologist who lost his medical license because he implanted hundreds of unneeded stents into people's coronary arteries. In the April 2012 issue of the Harvard Heart Letter, Editor in Chief Thomas Lee, M.D., writes that such blatant overuse of the health care system is rare and that "the vast majority of doctors put the people they treat first, far ahead of any personal financial interests."
The main driver of overuse is the fragmented health care system itself. Add to that the near-weekly market introduction of a new drug, technique, or device that promises to improve our well-being, and you have an environment that conspires to fuel overuse and medical cost inflation.
The solution to the fragmentation problem, says Dr. Lee, lies partly in the rearrangement of health care providers into groups that take collective responsibility for people's health care outcomes—and get paid accordingly. "Today, most doctors are paid piecemeal for what they do, and no doctor can take sole responsibility for a person's health because so many different providers and processes are involved," observes Dr. Lee. But it will take time to create these new integrated groups, called accountable care organizations (ACOs) and medical homes.
So until ACOs take hold, ask your doctor how the results of any test he or she orders will alter the way you're cared for. If your doctor can't answer that question to your satisfaction, consider declining the test—or finding a new doctor. "It's never inappropriate to ask whether a visit, test, or procedure is really necessary," advises Dr. Lee. "Sometimes raising such questions motivates a physician to consider alternative—perhaps even better—approaches."
The flip side of overuse is the fear that doctors might do too little—especially in the face of escalating health care costs. But efficient health care is not necessarily subpar health care, and Dr. Lee encourages everyone "to seek out and stick with physicians or physician groups that view efficiency as a dimension of quality."
Read the complete article: "Overuse, underuse, and valuable use"
The April Heart Letter also features stories covering:
- How to determine the seriousness of a fainting episode
- How the billions of bacteria living in your digestive system can affect your heart's health.
- The differences between systolic heart failure and diastolic heart failure
- In search of the wholly healthy muffin
The Harvard Heart Letter is available from Harvard Health Publications, the publishing division of Harvard Medical School, for $29 per year. Subscribe at www.health.harvard.edu/heart or by calling 877-649-9457 (toll-free).