If getting the right diagnosis will save big on health costs, why isn’t everyone doing it.
An opinion column in Saturday’s NJ Star ledger talked about the book Moneyball, which was a book and a movie which talked about the Oakland Athletics and how they as a less wealthy team used an unorthodox method of winning baseball games. The Author believes that if we used thought out of the box on how we look at health care to safe on costs, we would not have the problems we have on cost now, and that health care would indeed get better.
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Getting your medical diagnosis right: Opinion
Obama Sees Insurers; Health Law Is Subject
By JACKIE CALMES
Published: April 12, 2013
WASHINGTON — President Obama met with insurance industry executives at the White House on Friday to coordinate the introduction this fall of the insurance marketplaces at the heart of the national health care law, and to discuss so-called rate shock if the industry sharply raises premiums.
“We’re all in this together,” Mr. Obama told the executives, according to people with knowledge of the meeting, who spoke on the condition that they not be identified discussing it.
Government and industry, which battled while forging the law, are now “joined at the hip,” the president said at one point. “We’re going to make it work.”
For weeks, news reports have conveyed industry warnings that the new law could lead to higher premiums for many people, because the policies to be sold under the law’s requirements will be more comprehensive than those many Americans have now. Republicans in Congress, who remain united in opposition three years after the law’s enactment, have held hearings to underscore such warnings.
But the administration says such talk is overblown. Consumers can move from expensive health plans to more efficient, lower-cost policies, officials say, and critics who focus on premiums do not take account of other provisions of the law that limit how much consumers will spend out of pocket for health care.
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While the author of the article makes some good points, there is a problem with medical diagnosis in that while medical providers are great at figuring out heart and other organ system problems, and figuring out what to call these problems (the diagnosis), many symptoms that people experience exist in the myofascial system and the mechanical systems of the body, an area most medical providers are clearly lacking in diagnostic abilities. Since many conditions and symptoms blur the lines when we attempt to diagnose, and since many of these diagnoses lead to treatment which may or may not work depending on the accuracy of the diagnosis, we are led to experience too many MRI and other exams because the hands on evaluative work is not done. The end result is too many negative tests and the person is still in pain.
While the chiropractic profession and some arms of the medical profession such as physical therapy are well schooled in the art of musculoskeletal evaluation, the diagnosis even if it is technically correct does not always lead to an effective treatment because the right diagnosis is not descriptive enough when it is passed from provider to provider. Also, in medicine, there is this idea that the body is this disjointed series of parts that just go bad which leads to different specialists looking at them, without any regard for what is going on in the mechanism itself; which caused the dysfunction and the symptom. This results in treatment regimens that are ineffective.
A great example of this is visiting an orthopedic for the knee pain you are having without looking at the feet, the hip and the back, all areas that will cause knee pain. Years of ignoring it will result in bone on bone knee and the joint itself will be functionally bad. Having surgery for a bad meniscus is a way of ignoring it because it ignores why the injury happened. While most people seem satisfied by the surgery, additional injuries are bound to happen if the body mechanisms that went wrong were not addressed. If you have ever visited an orthopedic for knee pain, do you remember them looking at your feet; probably not, yet in our current diagnostic scheme, it is perfectly OK to diagnosed this as a patella-femoral syndrome, even if the problem really is caused by gait. This results in many people strengthening their legs and thigh muscles, without ever having the core, feet or the true causative factors behind the meniscus problem resolved or improved.
The problem with the poorly descriptive diagnosis is as bad as the problem of the wrong diagnosis.
All doctors use diagnostic verbiage, but the group think on what is appropriate and what is not should be revisited in the realm of the musculoskeletal diagnosis as well as in the disease paradigm. Too many healthy gall bladders as well as other organs are removed due to symptoms that are misunderstood. Years of non descriptive diagnosis has helped develop the business of replacement joints such as knees and hips. Are these parts really disposable and are the new ones as effective and useful as the original parts?
A better naming nomenclature with a more appropriate paradigm needs to be developed to help doctors understand their patients ills better. An example of a better way to name and diagnose may be with knee pain. If you remember the example of Patella Femoral syndrome which means the kneecap is tracking poorly can be used to demonstrate a more effective nomenclature. In the book, Cheating Mother Nature, what you need to know to beat chronic pain, it discusses kinetic chains, which are series of joints that affect another. In the example of knee pain we used, a better diagnostic nomenclature would be kneecap tracking syndrome secondary to foot overpronation (the foot flares out) and core stability. Since the knee is a conduit in the kinetic chain, any doctor would read this and understand the mechanism behind the pain and that this is a worthy diagnosis which tells you what the problem is caused by and how it needs to be handled. Any doctor who understands rehab would understand the person needs core training, work on the leg and also shoe inserts to stabilize the foot, which would reduce the stress on the knee.
While there are many more examples we can create, the idea is the diagnose first with a better background of understanding and then communicate that understanding through diagnosis with a better description which the rehab person or chiropractor can then use their expertise to solve the problem.
Better diagnosis is the problem, but a better diagnostic paradigm is the only way we can assure we will get a better diagnosis. This means most medical providers should improve their musculoskeletal evaluation skills in order to improve their ability to accurately diagnose and ultimately, this change will help healthcare costs go down by reducing the need for unneeded diagnostic tests and reducing the likelihood of having therapies that do not work.
Read Cheating Mother Nature, available through Amazon.com and other booksellers.