Don’t Stop Medical Innovation

The New York Times says “In Medicine, New Isn’t Always Improved.”

Who can argue with this?

“In Dining, New Restaurants Aren’t Always Better.”

Yes, that’s true, too.  But does it mean anything?

The article is about a type of hip that is apparently going to be the focus of a lawsuit.  The story goes that a lot of people wanted the new hip when it came out, because it was thought to be better than the older ones.  Unfortunately, the hip seems to have hurt some people, some of whom may have been better off getting the older one in the first place.

A doctor quoted in the article suggests it’s part of a uniquely American tic.  We want all of the latest and greatest things for ourselves, it seems.  This story is supposed to be a cautionary tale of what can go wrong when we do.

On the other hand, the latest and greatest things don’t appear out of nowhere.  In America, when people demand something, there will be someone who supplies it.

It’s true.  Doctors, researchers, the government, and, yes, for-profit companies, create things.  They invent diagnostic tests and treatments for disease that never existed before.  One reason why the U.S. has a trillion-dollar health care economy is because there are so many people creating so many new things that people can sanely talk about curing – or at least managing – all disease.  This is a good thing.

But all these breakthroughs are a two-edged sword.

The ability to create increasingly precise treatments means it’s more important than ever to diagnose patients correctly.  Published studies show that misdiagnosis rates are as high as 44 percent.  These studies show these errors happen because doctors are pressed for time, seeing 30 or 40 patients a day.  But whatever the cause, twenty-five percent of patients can’t possibly benefit from the latest medical advances – because they just don’t have the disease for which they are being treated.

Today we have the most medical knowledge, technology and treatments than at any time in history, and yet it’s harder than ever to get people the right care.  Policy-makers must fix an overburdened health care system in serious need of repair.  Let’s get back to basics.  Let’s put a premium on doctors’ judgment, not on how many patients they can see in a day.

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8 replies »

  1. The article shows that US doctors are better at reaching arbitrary, evidence-free endpoints that do not increase general health or life expectancy. ” Quality measurement” mentality at its worst.

  2. the misdiagnosis rates are certainly alarming. if doctors paid more attention to their patients instead of just rushing them out the door to get the next one in, people would be a lot better off.

    innovation is important, applying it correctly is more important (in my opinion)…

  3. Medical innovation is, I think, one of those occurrences that really never stops. Everyday somebody somewhere discovers something new, it won’t be long til those geniuses figure out the cure for every disease.

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  5. I dont know what Evan wants to tell us.

    “A doctor quoted in the article suggests it’s part of a uniquely American tic. We want all of the latest and greatest things for ourselves, it seems. This story is supposed to be a cautionary tale of what can go wrong when we do.” – I worked/trained in Germany and also spent a couple of mos in France. IMHO that’s flat out true.

    But I do not see a good connection between the 1st and the 2nd part of the article. Nonsensical medical innovation is about “new” (=patented, expensive) drugs, new devices, new prostheses, new imaging techniques … but arthritis of the hip, for instance, or hypertension, or diabetes (2 major areas of blockbuster drugs), are rarely misdiagnosed – rather, they are mismanaged, often 2ndary to pharma marketing (to providers and consumers), or 2ndary to pressure to go with the latest fad. Docs elsewhere are known to be more conservative than most (but not all) US docs – mostly to the benefit of their patients.

  6. So is there a clawback or some time of penalty when a physician doesn’t diagnose the problem correctly if we are going to place more economic emphasis on the diagnosis portion of the patient visit?

    I would be much more interested to see if there is any literature out there that looks at patient visit times & effects on actual outcomes besides patient satisfaction rates.

  7. It’s ironic that everything the policy wonks dream up to “reward” my cognition or judgment ends up doing exactly what you are arguing against – it necessitates me seeing more patients to pay for the cost of proving that I measure up. In the context of any discussion about rewarding physicians for their “judgement” or “cognition”, we of course must equate “measure” with “reward” because everyone knows those devious doctors will cheat if we don’t hold them accountable. Let’s make a medical home and add another FTE in the form of a case manager. Let’s mandate EHRs and add at least 1/2 FTE to scan that mountain of paper into digital form and of course then we have to pay that monthly fee and keep those computers humming along – have to see a few more patients to cover those expenses. And those new treatments you mentioned – can’t just let the doc go and order them, no, we have to make sure he followed the algorithm – add at least another 1/2 FTE to do preauthorizations. And finally, let’s try Pay for performance, but of course that rewards the doctor for giving the right treatment for the wrong diagnosis he made in the first place because he was too rushed, but that doesn’t matter, as long as he says it was CHF and started the ACEi we’re good with that. Check.