I came across a couple of articles recently that are worth sharing and discussing. The first points out that general physicals might not be all that useful, and the second – from fellow blogger David Williams – highlights the fact that overtreatment might just be more scary than the over-hyped idea of “healthcare rationing”.
General physicals. They’re sort of an untouchable aspect of healthcare. Everyone – both supporters and opponents of the ACA – seems to like the idea of preventive care and physicals (the discussion about who should pay for preventive care is another matter, but it’s rare for someone to come out and say that physicals are a waste of healthcare dollars). And yet maybe we’re not really getting much bang for our buck with them. It’s counter-intuitive, and sure to raise some hackles. There are lots of comments on the article; one says “This article is irresponsible. How could routine checkups NOT be a good thing?” Of course it’s answered by another comment that points out the results of the study cited in the article that found no difference in the risk of death or the risk of death from cancer or heart disease when comparing the group that accepted regular physical exams and the group that declined them. A good reminder that we need to check our “common sense” and “everyone knows that…” ideas at the door and pay more attention to peer-reviewed science instead.
The article itself – as well as several of the more well-thought-out comments – does note that there are some flaws with the study and that the results cannot be interpreted to mean that we should just abandon general physical exams as useless. But maybe we also shouldn’t automatically put them in the category of things-that-are-very-important-and-must-be-continued-at-all-costs.
David Williams’ article sums up some of the problems that arise from over-treatment and general healthcare overutilization. Duplicate testing and medications (often a result of a lack of coordination of care and/or a lack of readily-accessible medical records – both of which can be addressed by proper healthcare IT usage), as well as the stress, time and money that are wasted when we overuse healthcare. He points out that everyone is afraid of the word ration, but healthcare overutilization results in plenty of serious problems of its own – probably more than the “rationing” that some people envision as the future of our healthcare system. Politicians and special interest groups are well aware of the general fear and hatred of the idea of rationing anything, and they use that fear to their advantage to turn people against many of the healthcare cost-control measures that have been put forward. But overutilization is usually just thrown around as something that is detrimental because of the costs associated with it, but not a real problem for patients. David’s article succinctly highlights that this is not the case at all.
The two articles are related in that perhaps we need to consider at least some general physical exams to be overutilization of care. I know – that sounds blasphemous and counter-intuitive. But sometimes we have to abandon our preconceived ideas and look at what the evidence is telling us rather than just accepting what we assume we know to be true. I would say that further and more extensive studies need to be conducted before we make any radical changes as far as general physical exams and well-checks. But we definitely need to be taking a much closer look at healthcare overutilization. Maybe that’s where we can do our “rationing”, and end up with a win-win for everyone: lower healthcare spending and better patient outcomes.
