A Study a Day Keeps the Doctor Away
(Page 2 of 3)
Utne Reader September / October 2007
Leyla Kokmen
Such studies offer guidance for people weighing treatment options, but they also point toward fixes for our ailing health care system. Hahn calls evidence-based medicine one potential tool to create 'value' for patients by balancing costs with high-quality health care. This value, he says, is 'the only thing that's going to save patients from harm, and save our health care system from bankruptcy.'
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To improve individual health as well as the health of the system, researchers at the Dartmouth Atlas of Health Care analyze the use of medical resources throughout the United States by culling data on Medicare beneficiaries (which is considered a fairly accurate predictor of health care usage by those under 65 as well). That's how they found the tremendous geographic discrepancies in such high-cost procedures as mastectomies and back surgeries--variations that also contribute to big dollar discrepancies.
The atlas shows that health care for the average Medicare recipient in 2003 cost $11,352 in Miami and $7,783 in Detroit, but only $5,213 in Minneapolis.
'The system rewards high-cost procedures that have no benefit, that patients don't want, or, in fact, are harmful,' says Dr. Elliott Fisher, professor of medicine at Dartmouth Medical School and one of the directors of the atlas project.
While people may sometimes benefit just as much from medicinal therapy, lifestyle changes like diet and exercise, or even just waiting to see if a condition improves over time, doctors aren't reimbursed for talking to people about those options or helping them live comfortably with symptoms.
'We need to step back and ask, 'Is what we're doing really working?' That's the answer to some of our health care cost problems,' says Dr. Doug Campos-Outcalt, associate chair for family and community medicine at the University of Arizona. 'A lot of people are getting treatment they don't need, and a lot of people are making money on it.'
Critics contend that evidence-based medicine is too constricting, that it limits the evidence doctors can use to make their recommendations, ignores their experience and intuition, and discounts the 'art' of medicine. Worse, they warn, it could potentially tie physicians' hands when it comes to pursuing a wide range of treatment options.
'By anointing only a small sliver of research as best evidence and discarding or devaluing physician judgment and more than 90 percent of the medical literature, patients are forced into a one-size-fits-all straitjacket,' wrote Dr. Bernadine Healy, former director of the National Institutes of Health, in a U.S. News & World Report column (Sept. 11, 2006).