Dr. Rob Lamberts writes on his Musings of a Distractible Mind blog:
Asking for “more” has caused trouble over the ages. Adam and Eve wanted more food choices, the people of Pompeii wanted more mountain-side housing, Napoleon and Adolph Hitler wanted to spend more time in Russia, and America wanted more of the Kardashians. We can all see what destruction those desires reaped.
Americans have been viewing health care the same way, always wanting more: more antibiotics, more technology, more robots doing more surgery, more expensive treatments for more diseases. The result: health care costs more in America than anywhere else. Some folks think that our “more” approach makes our health care “the best in the world,” after all, where else can you get so many tests just by asking. MRI’s for back pain, x-rays for coughs, blood tests for anyone who dons the door of the ER. ”Tests for everyone!” shouts the bartender. “Tests are on the house! ”
They aren’t, of course, and we are paying the price for “more.” This hunger for “more” is fueled by the media’s fascination for the “latest thing,” the long disproved idea that technology will solve everything, and docs who aren’t willing to take time to explain why it’s actually better to do less. It’s hard to do, when we are paid more to spend less time with patients, and when the system is willing to pay for more and more.
Ultimately, I want my patients to see as few doctors, be sick as infrequently, and be on as few drugs as possible. I hope to wage an all-out assault on “more.”
Here are my rules to battle “more”
- Never order a test that doesn’t help you decide something important. Ordering tests “just to know” does much more harm than good.
- Use consultants only to do things you can’t. Orthopedists will aways give an NSAID and physical therapy for problems, so I don’t send patients to them unless they’ve failed those treatments (where appropriate). I am just as good at ordering PT, and am more careful with NSAID prescriptions than they are.
- Don’t give a patient a drug without explaining to them why they need it. If I can’t make a good case for a drug, I shouldn’t be giving it. This is not simply “to lower your cholesterol,” or “to treat your blood pressure,” but because doing so will raise your life-expectency.
- Remember the number that really matters: how many birthdays a person gets to celebrate in health. I don’t care about blood pressure, LDL, or even A1c if treating it doesn’t raise the birthday total.
- Don’t forget about another number: how much money patients have in their wallets. There’s no point in ordering a drug they can’t afford, or making them pay for a test they don’t need (even when they ask for either).
Last year, Lamberts announced he was making a “change from a traditional to a direct-care practice… I am only taking a maximum of 1000 patients (less at the start) and will be no longer accepting insurance. These changes make it impossible for me to continue in a doctor-patient relationship with most of my patients.”
This was one of his early posts about the change.
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