Overkill

May 11, 2015 -- In today's New Yorker, Dr. Atul Gawande hits yet another home run: "Overkill -- An avalanche of unnecessary medical care is harming patients physically and financially. What can we do about it?" He writes:

[We have] a new, unanticipated problem: ...the correct diagnosis of a disease that is never going to bother you in your lifetime. We�ve long assumed that if we screen a healthy population for diseases like cancer or coronary-artery disease, and catch those diseases early, we�ll be able to treat them before they get dangerously advanced, and save lives in large numbers. But it hasn�t turned out that way. For instance, cancer screening with mammography, ultrasound, and blood testing has dramatically increased the detection of breast, thyroid, and prostate cancer during the past quarter century. We�re treating hundreds of thousands more people each year for these diseases than we ever have. Yet only a tiny reduction in death, if any, has resulted... [emphasis mine]

The medical system [does] what it so often does: tests, unnecessarily, to reveal problems that aren�t quite problems to then be fixed, unnecessarily, at great expense and no little risk. Meanwhile, we avoid taking adequate care of the biggest problems that people face -- problems like diabetes, high blood pressure, or any number of less technologically intensive conditions. An entire health-care system has been devoted to this game. Yet [with the ACA and new standards of practice] we�re finally seeing evidence that the system can change.

He also follows up on a shocker he wrote five years ago, discussed here. He described the skewed incentives and thus excessive costs caused by our fee-for-service payment model, gradually being phased out thanks largely to an outcomes-and-quality-based model mandated by Obamacare.

Thanks, Dr. Gawande, for giving us new hope!

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