MedSmarts

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When Healthcare Turns Dubious

Healthcare You May Not Need

healthcare tests are often unnecessaryFor those who doubt the evidence cited in Our Healthcare Sucks, here’s another example of the arbitrary nature of many medical procedures routinely performed  across America.

This one concerns a cardiac procedure called left ventriculography that involves inserting a catheter across the aortic valve to the heart and injecting a contrast agent (dye) to detect mitral-valve and other structural abnormalities of the heart. This is most often done as part of a coronary angiographic procedure, generally on the growing ranks of those suffering with heart failure.

Sounds like pretty high-tech medicine, right? Actually, this one’s about 50 years old, but it’s still widely used because it’s convenient for interventional cardiologists to perform as an add-on to angiography – often even when previous non-invasive imaging exams have been performed that provide the same information.

Like a lot of things in healthcare that patients assume are agreed upon, this is one of many controversial healthcare practices with substantial disagreement about the need for the procedure – at least as frequently as it’s performed  in America – and about the benefit vs. the risks such procedures pose for often vulnerable patients.

And now there’s some fresh data to stir the pot anew…

Almost 9 in 10 Redundant

According to medical research from Stanford University, almost 90% of these procedures they studied among privately-insured patients were not, in fact, needed.

These researchers concluded that “Benefits are often minimal because the patients’ left ventricle (of the heart) can be – and usually is – more safely imaged using noninvasive methods.” According to the lead researcher, Dr. Ronald Witteles…

“From a medical justification standpoint, it almost would never make sense to be doing a left ventriculogram if somebody had already recently had an alternative assessment of their (heart’s) ejection fraction (pumping capacity)”…

…like the almost 90% of patients in the study who’d had just that.

“The Elephant in the Room”

Dr. Witteles – God love him – goes on..

“We cannot ignore the elephant in the room of the financial incentives. There’s a clear financial incentive for those performing the test to do this add-on procedure, which takes less than five minutes when you’re already doing a coronary angiogram…

“It does add a significant amount to the reimbursement procedure. That’s a real incentive we cannot ignore…

“When you see the numbers, it’s hard to ignore and not be shocked by them.”

According to physician income data cited in Our Healthcare Sucks, the interventional cardiologists who perform these invasive procedures averaged $468,000 a year in income as of 2009, with some making over $800,000 a year.

How much of that income is inflated by such rampant bill-padding, do you suppose?

Man the Barricades!!

As revealing as this study may be, the physician comments responding to the article reporting on this study at theheart.org are equally telling.

As you’d expect, they’re overwhelmingly defensive. One of them, from a “Dr. K”, unintentionally states the case for me…

“In a litigious climate where doctors perceive that testing reduces liability what percentage of any test do you think is likely appropriate…?”

My point exactly, “Dr. K”.

If you’re troubled by this line of reasoning – it’s all OK because everyone does it – you should be.

As the first of a few physician dissenters among those commenting on this study noted about the potential adverse effects of the dye used in this procedure…

“The (patients’) kidneys can do without the extra contrast (dye).”

He also noted that a noninvasive echocardiogram gives a more realistic assessment than the angiogram that’s skewed by sedating medications. anxiety, and catheter-induced reactions in the heart.

This physician – who wasn’t afraid to give his real name – concluded his comment with…

“Brave analysis and recommendation Dr. Witteles. I hope you get more support.”

Another physician dissenter agreed:

“The data acquired from left ventriculography is in most cases redundant.”

Take No False Comfort

This is only one of the many healthcare controversies that are common among physicians, yet largely invisible to their patients and the public generally.

These dubious healthcare practices have gotten so egregious the medical profession itself has joined in the effort to educate patients and their doctors about the most abused, as in overused, medical tests and procedures. The following video outlines the latest additions to this “Choosing Wisely” campaign:

Kudos to Doctors Stream and Topol for being so forthright in expressing the need for both doctors and patients to accept responsibility for correcting what Dr. Topol describes as an “epidemic” of overtesting in American healthcare. He ends this video on a somber note – that doctors are notoriously conservative about changing their behaviors and that little change, therefore, can be expected in the near-term future.

That leaves it to patients to accept the responsibility of questioning whether every test and procedure that’s recommended to them by their doctors is truly essential and what alternatives exist, including doing nothing or deferring to a future date (one aspect of healthcare overtesting is the frequency of follow-up testing, as both doctors mention in the video).

It also means patients need to stop asking for healthcare interventions they may not need – antibiotics for their kids’ cold and flu symptoms, for example. The understandable urge to “do something” is often ill-advised when it means interfering with the body’s own healing processes.

Many patients would rather not think about such things. It’s so much more comforting to just leave it up the doctors and hope for the best.

But this is false comfort when there’s so little actual agreement about what represents the best healthcare for you and your loved ones.

What about you? Are you willing to settle for such false comfort?

Or are you ready to start learning a few things to make your OWN opinion count when it’s your neck – or heart – on the line?

Well, are you?

You can start by visiting “Choosing Wisely” and reviewing what healthcare tests and procedures are often inappropriate. This doesn’t mean they’re always inappropriate, but it does mean you should think twice before agreeing to them for you or a loved one.

Add your thoughts below

This article is provided for educational and informational purposes only.
It does not constitute medical advice and should not be relied upon as such.

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2 Awesome Comments So Far

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  1. John Lynch
    March 3, 2013 at 10:05 am #

    Wow, you’ve covered a lot of ground there, Jaime. On one thing I certainly concur: Dubious IS an understatement.

    And for the record, Superman has X-ray vision, not laser vision…:-)

  2. John Lynch
    March 1, 2013 at 7:30 pm #

    Thanks for commenting, Sheila.

    Yes, there are plenty of highly ethical physicians and I’m happy to say I’ve worked with many of them over the years. But it’s the growing ranks of unethical ones that I focus on because most patients still don’t recognize they exist. This kind of naivety can prove very costly, and I don’t just mean in dollars-and-cents.

    As for the lawyers…well, malpractice lawsuits are at record lows, yet you’d never know it. It’s still the knee-jerk excuse to justify rampant overtesting. Yet in states that have capped patient damages in malpractice claims, there’s been no let-up in escalating healthcare costs. The take-home lesson? Malpractice is very often just a smokescreen to perpetuate highly profitable overtesting and overtreatment. Sad, but true.

    Thanks again for adding to the discussion.

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