Back when the ICU was the big profit center, people complained that they were often ”hooked up to machines” until death, even when they just wanted to stop or go home to die. Then, when the ICU became a potential big money loser due to capitation, we began to hear more complaints about patients being pushed to refuse expensive treatments and even being denied efficacious life-extending interventions they wanted under Futile Care Theory.
We have also been told for many years about how important preventative and screening tests are in catching disease early when it is more treatable. But now, we are about to be told to refuse many of such tests, and doctors are being urged not to offer them. From the NYT story:
In a move likely to alter treatment standards in hospitals and doctors’ offices nationwide, a group of nine medical specialty boards plans to recommend on Wednesday that doctors perform 45 common tests and procedures less often, and to urge patients to question these services if they are offered. Eight other specialty boards are preparing to follow suit with additional lists of procedures their members should perform far less often.
The list of tests and procedures they advise against includes EKGs done routinely during a physical, even when there is no sign of heart trouble, M.R.I.’s ordered whenever a patient complains of back pain, and antibiotics prescribed for mild sinusitis all quite common. The American College of Cardiology is urging heart specialists not to perform routine stress cardiac imaging in asymptomatic patients, and the American College of Radiology is telling radiologists not to run imaging scans on patients suffering from simple headaches. The American Gastroenterological Association is urging its physicians to prescribe the lowest doses of medication needed to control acid reflux disease. Even oncologists are being urged to cut back on scans for patients with early stage breast and prostate cancers that are not likely to spread, and kidney disease doctors are urged not to start chronic dialysis before having a serious discussion with the patient and family.
I’m sorry, but color me cynical. If these recommendations had been made before cost-cutting under Obamacare had become all the rage, before the Medical Establishment began to embrace health care rationing, before we were told that screenings were good, the more the better, I might be less distrusting. Bingo:
Some experts estimate that up to one-third of the $2 trillion of annual health care costs in the United States each year is spent on unnecessary hospitalizations and tests, unproven treatments, ineffective new drugs and medical devices, and futile care at the end of life.
As we know, “futile care at the end of life” is often treatment that works, when the patient is the one really deemed “futile.”
I am not saying that these recommendations are wrong. Perhaps the original standards of care were erroneous, which in itself would beg several questions. I am saying that these reversals of course—which just coincidentally happen to match the current medical economic zeitgeist—does not exactly boost credibility. Or to put it another way, my trust level is definitely not what I would prefer.
P.S. Doctors are really being put between a rock and a hard place these days. Their general compensation is being strained. If not giving these tests results in a patient’s cancer not being caught when it was treatable, or someone dying sooner of kidney disease, they will be sued to Timbuktu. But under the Obamacare cost/benefit boards—which I believe these changes are being teed up for to allow a declaration of general non coverage—there will be no payment permitted if they are ordered. Yikes.