With the dizzying array of initiatives currently underway to bring more efficiency to the nation’s healthcare system, I was interested in an interview that ran in last week’s New York Times’ Well blog: a Q&A with Dr. Otis Brawley, chief medical officer of the American Cancer Society, who has just published a book: “How We Do Harm: A Doctor Breaks Ranks About Being Sick in America.”
Dr. Brawley talks about problems in American healthcare, and calls into question the assumption that more is better—that more tests, treatments, and drugs are synonymous with better care. It’s a notion that’s dead wrong, he says. In his view, discussions about healthcare reform and high costs of care are often based on an assumption that there is a lack of healthcare, but some people do not recognize that both overuse of healthcare as well as lack of access to healthcare are problems: both cause suffering.
“People are so focused on fears of rationing healthcare,” he told the interviewer. “The talk should not be about rationing healthcare, but rational healthcare. So much of what we do is irrational.”
Dr. Brawley says that every party in healthcare chain holds some responsibility: hospitals, drug companies, insurance companies, doctors and patients. He gives an example a cancer patient who shopped around for an inappropriate chemotherapy treatment; and accuses the industry of overselling the potential benefits of prostate cancer screenings. He says he wrote the book to stress the need for more rational use of healthcare, and that people are being hurt by overtreatment.
I think Dr. Brawley makes an important point, especially now, when more and more providers are going to great lengths to use data to improve patient care and drive better outcomes for treatments. Many of the initiatives taking place under healthcare reform point to more intelligent healthcare, not more of it. But I do think there is a need for educating the public about the risks of overtreatment, and everyone in healthcare needs to get on board.
And there has been some movement in this direction. A few weeks ago, as reported in the Times, a group of nine medical specialty boards announced they would recommend that doctors perform 45 common tests and procedures less often, and to urge patients to question the services if they are offered. In a campaign, called Choosing Wisely, by the American Board of Internal Medicine Foundation, in partnership with Consumer Reports, a group of nine medical specialty organizations identified procedures in their fields that should be discussed or questioned.
