Managing medicine: when more is less
Everyone's heard the expressions "Less is more" and "simplicity is best." These phrases make good conversation fillers, but now lack any real meaning as they have become trite through overuse. This is unfortunate. In just about any business, simplicity is always better. Less usually is actually more, provided there's a good design and interface to back up a given product. Now, it seems, medicine is coming into line with these same theoretical views.
Fisher originally expected to find that people in areas with more healthcare would be healthier and longer-lived. The opposite was true. "If anything, it looks like there is a substantially increased risk of death if cared for in high-cost systems," he says. The reason: The additional tests and procedures in the high-cost areas bring more risks than benefits. "A large portion of those extra costs are due just to proximity to health care," says George Bennett, CEO of Health Dialog Analytic Solutions, which tries to get unbiased information to patients. "Not all those expenditures are optimal or even appropriate."
These findings seem to mirror a growing trend towards "managing" medicine to achieve positive therapeutic outcomes. While tailored drug and treatment regimens might make a patient feel good about their care, this is often a sub-optimal solution to whatever ails them. This has led to several innovative advances is medicinal computing and achieving positive outcomes through evidence-based medicine. The Archimedes project springs readily to mind.
There's a push and pull, of course. Doctors get paid for procedures they perform, and they don't get paid if they don't perform them. Most docs aren't money-hungry treatment-pushers, but they do arguably have vested interests on both sides of the dollar sign. On the one hand there are their patients who might benefit more from simply letting things ride, and then there are the revenues for their hospital or practice that they stand to generate if they prescribe a certain treatment or test. And then there's also the issue of "patient satisfaction," which in the era of medicine-as-a-business places more emphasis on keeping the customer happy than it does on positive therapeutic outcomes. This leads to the phenomenon of patients feeling entitled to a prescription simply because they visited their doctor. If the doc doesn't provide at least something, the patient may feel as though they aren't truly being served. It's a tough balancing act, and these pressures are the reasons things like antibiotic-resistant bacteria are becoming a bigger problems in the first world.
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