Benjamin Franklin is credited with once saying “The definition of insanity is doing the same thing over and over and expecting a different result.” Such is the state of modern healthcare. We all want costs to go down, but how have we actually changed our approach to managing patients? Medical students on the wards are still inundated with traditional teachings: “Start the patient on IV x, y, and z!” Why? “Because we’ve always done it.” Hmmm, insanity indeed.
While at Ben Taub, every patient I had (regardless of what they were admitted for) was started on a proton pump inhibitor (PPI) for “prophylaxis against stress ulcers.” I can imagine this being important in patients who, for example, cannot protect their airway and are consequently at risk for aspiration; however, in a patient with an easily treated lower extremity cellulitis, there’s just no need. At St. Luke’s, we routinely start patients (who can tolerate po intake) with peptic ulcer disease on IV Protonix and then transition over to oral Protonix at discharge. Why is this a big deal? Two reasons: a.) the IV and po (oral) forms essentially have the same efficacy, and b.) IV Protonix costs well over 10x as much as oral Protonix. Just in the context of PPIs, imagine how much we’re wasting… each day… per patient. 😯
Another example that my attending and I were discussing earlier today – if you’re doing an upper GI endoscopy or colonoscopy and happen to stumble on an incidental finding (ie, a polyp), go ahead and biopsy!! It takes two seconds and spares the patient the trouble of having to be a.) readmitted to the hospital, b.) prepped for the procedure, and c.) risk the dangers of not catching a diagnosis early. In this case, the additional expense is well justified, and if anything, the patient’s long-term treatment is more efficient.
These are just two minor examples of how we’re constantly wasting health care resources on a daily basis. As the next generation of health care providers, medical students need to focus on understanding that patients are stabilized in the hospital, but actually recover at home. In the next decade, the health care system won’t be able to afford keeping patients in the hospital for extra days to be monitored or await further work-up. Efficiency goes a long, long way in this “health care reform.” In the end, whatever provisions Capitol Hill generates will pail in comparison to a physician’s ability to conscientiously plan the treatment of his or her patients every single day.
good thoughts. do you think IM doctors are more guilty of waste than others?
As a student, I’m really not in a position to say that one field is “more guilty” than another given that I’m still on my first clinical rotation. 😀 I surmise that every specialty has areas where resources can be allocated much more efficiently.
That wastefulness is disgusting. I think you’re right about the need to shift the mindset of future healthcare providers. We set up the environment to best allow the patient to heal themselves.