Dr. SSS: The two most expensive words in medicine

The following is a reader take by Dr. SSS.

We talk about the current healthcare crisis, the wasted dollars in medicine, the rising cost of healthcare and yet there is no real increase in the quality of the care provided. Defensive medicine is a key to this waste of money in the healthcare system. Cutting reimbursement of physicians, recruiting mid-level personnel or switching to generic medications is like treating cancer with Tylenol. Even though defensive medicine is discussed, I do not think anyone outside medicine understands it at all.

I’d like to show the disastrous effects of defensive medicine with numbers. Let’s look at a hypothetical, yet conservative, estimate of the wasted dollars in medicine on musculoskeletal chest pain.

I am an internist and I frequently receive a calls from the ER asking me to admit a patient with chest pain, which on clinical history is “almost certainly” musculoskeletal in origin. However, my friends in the ER have already documented it as “rule out MI”. Now my “almost certainly” will hold no water in the court of law after a bad outcome. Thus, I’m forced to put the patient in for an overnight stay. Sometimes it is difficult for me to understand if I am really treating myself or the patient.

Let’s get back to the numbers. The two words “almost certainly” may be the most expensive words in terms of health care dollars. Here’s why:

* Consider that there are more than 100,000 primary care physicians in the United States (a conservative estimate)

* Assume a single “chest pain, rule out MI” admission costs $2,000 dollars (again, a conservative estimate, as one of my patients was billed $10,000 for a single night stay)

* Assume every primary care physician admits at least one “almost certainly” musculoskeletal chest pain for an overnight observation in the hospital at least once a week

Once we have digested these numbers, it is time to do the math.

If the above statements are true, the total amount of money wasted on an “almost certainly” musculoskeletal chest pain annually is:

100,000 x 2,000 x 52 = $ 10,400,000,000 per year

A whopping $10 billion dollars are wasted on a single diagnosis every single year. Even if you set aside $1 billion to pay the malpractice lawyers on a yearly basis, you still save $9 billion a year on a single diagnosis.

Putting needles and IV dyes into a patient who “almost certainly” does not need it is not standard of care. Every single day, the threat of malpractice suits forces well-meaning physicians to do so. Every single day, more patients go through unnecessary tests to protect the physicians from malpractice.

That, I’m certain of.

Dr. SSS is an internal medicine physician who blogs at CareerMedicine.com.

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