Noelle Swan

Is the Current Healthcare System Driving the Nation to Economic Collapse?

In Healthcare on September 23, 2011 at 2:26 pm

This article was first published by New England Post on September 23, 2011.

“Healthcare costs are destroying our American prosperity and even beginning to destroy the American dream,” Dr. Atul Gawande told the Harvard Institute for Learning in Retirement, Wednesday in a lecture entitled “The Battle for the Soul of Medicine.”

Gawunde is a surgeon at Brigham and Women’s Hospital, associate professor at Harvard School of Public Health, and regular contributor to The New Yorker. He is the author of three books including The Checklist Manifesto in which he prescribes a 19-item checklist for surgical teams to address before each surgery. He has been presenting his “Battle for the Soul of Medicine” lecture around the country for a year warning of impending economic medical collapse if healthcare costs are not reigned in within the decade.

These concerns are nothing new to Boston area medical and public health professionals. Dr. Alan Sager, Boston University professor of public health and management and director of BU’s Health Reform Program has been weighing these problems for a decade and testified before Congress about such matters.

In a telephone interview following Gawunde’s lecture, Sager confirms Gawunde’s concerns. “We’re already there,” he said. “There are huge signs of that already,” and cited individual state struggles to cover ever rising Medicare costs.

Gawunde, however, remained optimistic.

“The answer is right in front of us. We can rediscover our American ability to solve problems,” he said and offered his checklists as one solution.

Gawunde advocated medical culture that looks beyond providing individuals the best training and hospitals the best technology to a system where individual doctors work in concert. “We’ve trained all of our physicians to be cowboys when we need pit crews,” Gawunde said. It used to be that individual doctors could “do it all,” he explained.

But medicine has changed.

“We now understand there are 13,600 different ways that the human body can fail. There are 6000 drugs that I can legally prescribe and 4,000 medical and surgical procedures to choose from,” Gawunde said. Where doctors once prescribed an aspirin, they now might recommend a knee replacement. A knee replacement requires a lot more doctors than an aspirin and those doctors need to work together he said, then added “cowboys aren’t even cowboys anymore. They drive in teams and have specific protocols that they follow…checklists.” ”

However, even cowboys and pit crews need a leader, someone to coordinate efforts and reduce redundancy.

Sager said he sees primary care physicians as the key to unlocking the healthcare crisis. A shortage of primary care doctors means that full time physicians care for 1500 to 4000 patients, he said. He said an increase of 300,000, full-time equivalent primary care doctors would bring the doctor to patient ratio down to 1 doctor for 1000 patients. He predicted this would improve the overall quality of primary and secondary care and reduce reliance on expensive hospitals for routine care.

Dr. Gregg Meyer, primary care physician and vice president of quality and safety at Mass General Hospital agreed in a telephone interview that there is much to be gained from an investment in primary care doctors.

“I think there is strong evidence to say that if we invested more in primary care and we did it in the right way, that we could make a dent in health care costs,” said Meyer. However, primary care is not an attractive field to medical students, he qualified. He added that primary care doctors are often overworked and underpaid.

American cultural norms contribute to excessive medical costs, as well. Dr. Karen Thomas, cardiologist at Beth Israel Deaconess Medical Center and Mount Auburn Hospital said in a telephone interview that she often felt trapped as a physician by cultural expectations.

“Americans think they should be able to live forever and they should be able to spend millions and millions of dollars to do so at no personal cost to themselves,” says Thomas. “We just don’t have $50,000 to be putting a preventative device in a 90 year old.” Still families want their loved ones to receive every medical advantage possible, and Medicare will readily pay for it.

Sager suggested that physicians benefit from over providing. More tests mean more visits and more visits mean more fees. “Financial incentives to over-serve and fear of being sued come together as two mighty rivers and lead to a flood of over-care.”

Thomas admitted to ordering tests that she knew were probably not necessary in order to avoid a potential lawsuit. Meyer said that this is a problem throughout the United States and should be a major subject in the national healthcare dialogue.

Gawunde called the identification of these problems as the first step. His checklists are one idea for addressing the problem of errors. As Doctors Sager, Meyer, and Thomas pointed out, problems abound in the current medical system. Only time will tell how these problems will be addressed.

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