Two Common Sources of Overtreatment
By Jim Sabin Experts, most recently former CMS administrator Don Berwick, tell us that no less than 20% – 30% of medical care is “waste.” At the very least, “waste” is harmful to all those who pay for Medicare. But often it’s directly harmful to the patient as well. I recently saw a friend at a party. Since we’d last seen each other my friend’s spouse had died. (I’m deliberately avoiding gendered pronouns and omitting other identifying details.) My friend contrasted the excellent hospice care the spouse received with problem-ridden hospital care. Here are two examples of...
Read MoreChoosing Wisely and Delivering Value in Obstetrics & Gynecology
By Neel Shah, MD- Executive Director, Costs of Care The pressure on physicians to provide better care at lower costs is coming from all directions – top down from policymakers who want more accountability in how healthcare resources are being used and bottom up from patients who want more transparency in how their money is being spent. Obstetrician and gynecologists have not been spared any scrutiny. As primary care providers for many women we are in thick of the debate on appropriate use of pap and mammography screening. As surgeons we also find ourselves increasingly answering for the...
Read MoreThe Cost of an Ounce of Prevention
By Josh Trent “Have you ever been told you have a heart murmur?” a young doctor gently asked my friend, Ben. Ben’s mind reeled. Ben was in his early 30s, relatively young and healthy. But his father had died from a heart attack before age 50. And his mother had a heart problem. What did this question signal for him, he worried. “Um, ah, no, I haven’t,” Ben managed to murmur in reply. The doctor told Ben he wanted to get a sonogram to have a picture of Ben’s heart. He scribbled an order on a form and told Ben of a nearby cardiologist. Ben thanked the doctor and wrapped up...
Read MoreAlliance Between the Generations for Responsible Medicare Savings
The following post is by Jim Sabin, a Clinical Professor in the Departments of Population Medicine and Psychiatry at Harvard Medical School, Director of the Ethics Program at Harvard Pilgrim Health Care, and a blogger at the website “Over 65.” Jim has been in healthcare for almost 50 years — as psychiatrist, medical director, teacher/researcher, consultant, leader of the ethics program at a not-for-profit health plan, and patient. There’s no way to address long term financial health in the U.S. without including Medicare savings in the mix. But political...
Read More‘I’m sorry ma’am, but we do not accept Medicaid patients’
The following essay is by Beth England, a second year medical student at Virginia Tech Carilion School of Medicine and a contestant in the 2012 Costs of Care Essay Contest. While I am currently a second year medical student, my story is one of a sister. When I was six years old, my mother asked me a question that would forever change my childhood- “Honey, would you be alright with having a foster child join our family? It would mean a little boy coming to live with us for a while.” My response did not take much thought; how could I refuse a new playmate? His name was John, and he was 4...
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