![]() ![]() We didn’t do that until later, by which time the real source of her symptoms, a twisted loop of bowel in her pelvis, had turned gangrenous, requiring surgery. If I had, I might have ordered a pelvic CT scan or even recommended exploratory surgery to investigate further. ![]() She insisted that she hadn’t been sexually active, but I didn’t listen. I examined her and found signs of pelvic inflammatory disease, which is most often caused by sexually transmitted diseases. More than a decade ago, I saw a young woman in the emergency room who had severe pelvic pain. It’s the scan, the test, the operation that I should have done that sticks with me-sometimes for years. Why does this fact barely seem to register publicly? Well, as a doctor, I am far more concerned about doing too little than doing too much. But years of research, including randomized trials, have shown that the operation is of no help for chronic arthritis- or age-related damage.) (Arthroscopy can repair certain types of acute tears to the cartilage of the knee. Four patients had undergone inappropriate arthroscopic knee surgery for chronic joint damage. A third patient had undergone surgery for a lump that was bothering him, but whatever the surgeon removed it wasn’t the lump-the patient still had it after the operation. (An MRI does not image thyroid cancer nearly as well as the ultrasound the patient had already had.) The other received a new, expensive, and, in her circumstances, irrelevant type of genetic testing. One was sent for an MRI after an ultrasound and a biopsy of a neck lump proved suspicious for thyroid cancer. Two of the patients had been given high-cost diagnostic tests of no value. To my surprise, it appeared that seven of those eight had received unnecessary care. One saw me about a hernia, one about a fatty lump growing in her arm, one about a hormone-secreting mass in her chest, and five about thyroid cancer. In my clinic that afternoon, I saw eight new patients with records complete enough that I could review their past medical history in detail. I am a general surgeon with a specialty in tumors of the thyroid and other endocrine organs. Now a far more detailed study confirmed that such waste was pervasive. ![]() Bigger than any of those, however, was the amount spent on unnecessary health-care services. The report found that higher prices, administrative expenses, and fraud accounted for almost half of this waste. But was McAllen an anomaly or did it represent an emerging norm? In 2010, the Institute of Medicine issued a report stating that waste accounted for thirty per cent of health-care spending, or some seven hundred and fifty billion dollars a year, which was more than our nation’s entire budget for K-12 education. In just a single year, the researchers reported, twenty-five to forty-two per cent of Medicare patients received at least one of the twenty-six useless tests and treatments.Ĭould pointless medical care really be that widespread? Six years ago, I wrote an article for this magazine, titled “The Cost Conundrum,” which explored the problem of unnecessary care in McAllen, Texas, a community with some of the highest per-capita costs for Medicare in the nation. Their list included doing an EEG for an uncomplicated headache (EEGs are for diagnosing seizure disorders, not headaches), or doing a CT or MRI scan for low-back pain in patients without any signs of a neurological problem (studies consistently show that scanning such patients adds nothing except cost), or putting a coronary-artery stent in patients with stable cardiac disease (the likelihood of a heart attack or death after five years is unaffected by the stent). They studied how often people received one of twenty-six tests or treatments that scientific and professional organizations have consistently determined to have no benefit or to be outright harmful. The researchers called it “low-value care.” But, really, it was no-value care. It suggested that a huge proportion had received care that was simply a waste. The one that got me thinking, however, was a study of more than a million Medicare patients. Among those which caught my eye: a British case report on the first 3-D-printed hip implanted in a human being, a Canadian analysis of the rising volume of emergency-room visits by children who have ingested magnets, and a Colorado study finding that the percentage of fatal motor-vehicle accidents involving marijuana had doubled since its commercial distribution became legal. It was lunchtime before my afternoon surgery clinic, which meant that I was at my desk, eating a ham-and-cheese sandwich and clicking through medical articles. Millions of Americans get tests, drugs, and operations that won’t make them better, may cause harm, and cost billions.
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