Here’s an example of bad primary care

As much as I have given the “ologists” and other members of the dysfunctional U.S. health care system a hard time in previous posts, it’s only fair that I call out bad family medicine as well. I have a great example.

I recently saw patient who is relatively new to the area who had seen another family physician in my community. He is 39-year-old male, and his only significant potential health problem is borderline hypertension.

When he came to see me, he brought a bag full of about six medicines and was scared because he was told that he had a whole host of medical problems. Best I can tell, there were some insurance issues that caused him to seek care at my facility: private doctors not taking one of the low-pay exchange plans I suspect. He had saved a copy of the paperwork he received from the previous family physician, which included a “complete set of blood work.”

It would take too long to write out all that he was subjected to, so I’ll give you the main categories of blood tests. They included panels (meaning more than one test per panel) of labs for cardiac dysfunction, cardio-metabolic markers, lipids, lipoprotein particles and apolipoproteins, inflammation oxidation markers, myocardial stress/function, platelet function, lipoprotein genetics, platelet genetics, coagulation genetics, other metabolic functions, renal, sterol absorption markers, sterol synthesis markers, glycemic control (more than an A1c), insulin resistance, beta cell function, electrolytes, liver functions, male and female hormones, thyroid function (8 tests in that panel), urinalysis, CBC with differential, PSA, omega-3 fatty acids, omega-6 fatty acids, other fatty acids, and a few more that are harder to categorize.

The patient’s TSH was perfectly normal, but this doctor had prescribed levothyroxine. His cholesterol was 203, LDL 133 and HDL 54, but she put him on a statin. His blood pressure, best I can tell, was never measured higher than the low 150s, but he was prescribed three blood pressure medicines. His pressure was way on the low side of the normal range when measured at my clinic. He also brought a list of stuff from the grocery store he was supposed to take every day such as so many teaspoons of cinnamon, cloves, and some other plants and spices.

What an incredible waste. This poor guy was exposed to financial harm, psychological harm, and completely unnecessary medications. I made my best guess about the minimal regimen he would require to keep him in good stead for the next few years (one blood pressure medicine). I have not seen him back yet for follow-up.

I wish there were some mechanism to report this heinous care that did not involve the state medical board. This lousy care is just as bad as when a cardiologist performed an unnecessary stent or an orthopedist does an unnecessary joint replacement.

At least I have a glimmer of hope that this kind of behavior could be captured using billing data. As the pundits talk about quality of care and metrics, reforming this kind of outlier poor performance would be much more meaningful to our country’s future than the meaningless use criteria being foisted on us now.

Richard Young is a family physician who blogs at American Health Scare.

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