If you had to write a one page memo to a Senator/Representative detailing the one thing they could do to improve US healthcare, what would it be?
For me, it’s improving the wastefulness of our system. Here is my attempt at a memo:
Comparative Effectiveness Research is a win-win: Knowledge always is.
US healthcare is too big and too wasteful. Inefficiency is the conflict that needs resolution. Dare I say there is too much fat in our system?
As an experienced physician, I believe the main cause of inefficiency is a deficit in knowledge. When we donâ€™t know something, we are often scared. Fear and ignorance pushes the culture of medicine towards inefficiency. (Disordered incentives contribute as wellâ€”but thatâ€™s another memo.)
When I see a patient with a heart rhythm problem, the most effective tool I possess is not a procedure; itâ€™s communication and education. Patients and their referring doctors are often fearful and uniformed. Thatâ€™s a bad combination, one that can lead to aggressive and inefficient treatment.
Doctors donâ€™t know enough about their therapies; patients donâ€™t know their options. Both parties assume more is better; that action is better than inaction. We donâ€™t know enough because we havenâ€™t asked the right questions.
This is why patient-centered Comparative Effectiveness Research holds such great promise. Yes, itâ€™s a new idea, and the entrenched culture of medicine will not change easily, but it can, and it will.
Doctors are good people who want to do the right thing for their patients. Their self-esteem depends on how much they help people. Right now, the right-thing default is to do something, anything. And itâ€™s not just caregivers; patients have come to expect action. We screen, we test, and we treat, because we want to help. Yet we donâ€™t know whether these actions are effective. Worse, we donâ€™t whether they align with our patientsâ€™ goals.
I recently wrote an essay about changing the culture of Medicine. It was a plea for patients and doctors to consider the value of evidence-based practice. NIH researchers studied medical reversals over the past decade. They found that 146 common practices, things we were sure of, like ear tubes for children, hormone replacement therapy for women and strict control of blood sugar in hospitalized patients, turned out to be ineffective and in some cases harmful.
At the core of these ineffective wasteful treatments were deficits in knowledge. We meant well, but we didnâ€™t know. Comparative effectiveness research will teach both patients and doctors alike. Thatâ€™s a win-win.
We donâ€™t have to ration care; all we have to do is improve decision quality with knowledge. Removing fear and ignorance, aligning care with whatâ€™s important to the patientâ€”this is the path to efficient and compassionate health care. I am sure of it.