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Friday, April 13, 2012

The Council Has Spoken!! This Week's Watcher's Council Results


The Council has spoken, the votes have been cast, and the results are in for this week's Watcher's Council match up.

As a number of commentators have said (including yours truly)if someone isn't willing to look at tort reform, they're not serious about controlling the riding costs of healthcare.

This week's winner,The Razor's Why There Are No Such Things As Unnecessary Tests examines this from a physician's viewpoint. Here's a slice:

My wife is a family doctor working in a small rural practice owned by a regional hospital. While she has not yet been sued for malpractice she knows many doctors who have, and while the vast majority of these suits never reach court they still inflicted many sleepless nights and higher malpractice premiums on the innocent doctors. She recognizes that everything she does may have to be justified someday so that if she is forced to testify she can explain the rationale of her treatment. This is the essence of defensive medicine.

The American Board of Internal Medicine Foundation in partnership with Consumer Reports has announced Choose Wisely, an educational initiative recommending physicians avoid 45 unnecessary tests and procedures the group believes are performed unnecessarily. These include routine EKGs and Stress Tests as well as prescribing antibiotics for minor ailments such as mild sinusitis. Oncologists are also encouraged not to perform cancer screens on breast cancer and prostate cancer patients diagnosed with non-metastatic forms of these cancers.

But as the New York Times article states, these recommendations are controversial and there is fear among some patients and doctors that they will be applied too broadly. The newspaper quotes Dr. Eric Topol, chief academic officer of Scripps Health who says, “These all sound reasonable, but don’t forget that every person you’re looking after is unique…This kind of one-size-fits-all approach can be a real detriment to good care.”

As a resident of the great state that raised John Edwards to the heights of power on the backs of doctors he sued for malpractice, I’m skeptical over this recommendation for a number of reasons. Dr. Topol makes an excellent point. Those who aren’t health care practitioners may fail to understand that patients often do not present with clear cut symptoms. There is a finite number or reasons your car won’t start in the morning such as the battery is dead, the tank is empty or the ECM needs replacement. But the human body is infinitely more complex. What may present as back pain from too much Pilates can turn out to be bone cancer that had metastasized from the esophagus, as happened to my father-in-law. The chronic tickle in the back of the throat that drove my mother-in-law crazy for months, turned out to be an atypical and rare form of breast cancer. Both were dead within months of their initial complaints both were misdiagnosed by their primary care physicians, though it is unlikely in either case the proper diagnosis would have mattered much. But both cases of cancer could have been treated had they been detected early. Obviously doctors cannot perform these tests on everyone because it would take too much time and cost too much, but this decision should be left to the judgment of the doctor and not interfered with by the government, an insurance company or a non-elected body such as the American Board of Internal Medicine Foundation.

These recommendations will no doubt be cheered by insurance companies and the government (since Medicare, Medicaid and Obamacare make the government a de facto insurance company I’ll lump it together with the likes of Kaiser Permanente and Blue Cross for the rest of the article.) Insurance companies can now refuse to pay for these tests or at the least requiring doctors jump through time-consuming and money-losing hoops such as requiring pre-authorization to do them. The article claims that as much as 1/3 of the $2 trillion spent on health care in the USA is unnecessary, so imagine the savings to their bottom lines these companies will enjoy by cutting nearly $700 million from their payments. The problem with this figure is that it’s like the old saying about half of marketing dollars being wasted, but no one knows which half. Because it is impossible to accurately determine which person needs a test and which doesn’t it will be impossible to reap the savings hinted at in these recommendations.

In our non-Council category, the winner was Sultan Knish for One Hundred Broken Mirrors submitted by The Political Commentator, a fascinating look at how history repeats itself and how America looks to the countries we're trying to 'sell' our brand of democracy to.

Here are this week’s full results. New Zeal Gay Patriot and Simply Jews were unable to vote this week.

Council Winners



Non-Council Winners



See you next week! And don't forget to follow us on Facebook and Twitter..'cause we're cool like that!
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