The NY Times recently looked into why doctors have such a hard time learning new things. One of the most difficult problems is to teach doctors to unlearn bad habits in the past which would can lead to lower costs and less potentially harmful practices. Many of these practices are driving healthcare costs.
Recently, a systematic review in JAMA Pediatrics looked at the overuse in pediatric care in 2016 regarding Pedialyte use that was more expensive than other less expensive drinks that essentially do the same thing. Another example is the overuse of antibiotics for ear infections which had been a mainstay of treatment 20 years ago.
There are more examples that are relevant today including the continued use of pain relieves and opioids for problems such as back pain which are poorly understood medically, yet pain management professionals continue to recommend medications even as the Journals medical professionals read suggest that they refer to chiropractors and other drugless health professionals first for the care of these conditions. Many doctors continue to recommend other medical specialties that are less effective, less safe and continue to use drugs for problems that are best treated with movement based professionals such as chiropractors who have the best reputation for treating this type of problem.
Part of the problem exists because medical continuing education does not offer additional training in the evaluation and treatment of musculoskeletal problems. Forcing doctors to change such as what Medicare is now doing by monitoring primary care costs both in the office and after they refer and either bonusing or reducing payments based on their efficiency of referral patterns is likely to cause more resentment than change. Since many continuing education programs are run by the pharmaceutical industry who heavily subsidizes the cost of these programs, it is highly unlikely they will sponsor programs that do not sell drugs. It would be appropriate to ask if big pharma is part of the cost and referral problem in healthcare?
Recently, one of our employees have me look at her daughter because she had pain in her elbow on the inside of the arm. My evaluation showed that the entire left side was tight, she had reduced external rotation of the arm and there was a ganglion cyst at the front of the elbow which I treated and reduced in size during that visit, while improving the way her left side functioned. According to her mom, she first had her primary doctor look at it and his recommendation was to see and orthopedic, have an MRI and perhaps have some other tests which would have been costly and unhelpful. Instead, the ganglion is now half the size, and her arm, shoulder and leg and lower back are now feeling better. If the system had continuing education that was required for primary care regarding the musculoskeletal system, would this doctors referral patterns and use of resources change? Perhaps, he would realize that he needs to refer to chiropractors more often to quickly resolve problems like these.
Poor referral habits should be addressed through reforms in the system, reeducation and perhaps, insurers need to add more guidance on whom they will allow primary care doctors to refer to. Over time, doctors will change their habits of referral, the same way they will change their habits of what procedures they will recommend or perform when the current medical literature no longer supports their usage. On the other hand, doctors must be patient centered and recommend and refer based on effectiveness, rather than on referral habits. It would also be helpful if they visit come of these types of providers such as chiropractors to better understand why they are helpful and more effective, and perhaps experience these approaches to care first hand.
The other part of these bad habits has to do with costs and investment. Part of what drives x ray usage is need, while another part of what drives usage is the cost of running and keeping a machine in operation and of course, there is the need for profit so someone can afford to run a medical office. These are the realities that are present in today’s market place. Of course, there is also the choosing wisely campaign designed to reduce the amount of x rays however, often, providers may want these imaging studies to protect themselves from missing something and then being sued for it. The truth is, if they learned better skills for evaluation musculoskeletal problems, they would require fewer films. To simply call these bad habits when they were not adequately trained to evaluate these types of problems and when they refer them on to a surgeon such as an orthopedic just because they do, is a huge cost driver. Again, this should be part of continuing education training for all medical providers.
When the use of PSA testing was being discouraged because too many men were scared into having a procedure that may have harmed them, based on a faulty test. At the time, right after the information was published, the hospitals who treated the condition doubled down on their advertising to make sure their investments in treatment machinery were being paid for. Were doctors changing their referral and testing patterns as well?
Check out the article below
It’s Hard for Doctors to Unlearn Things. That’s Costly for All of Us.
Procedures live on even after they’ve been proved ineffective. It can lead to harms and wasted resources.
We know it can be hard to persuade physicians to do some things that have proven benefits, such as monitor blood pressure or keep patients on anticoagulants. But it might be even harder to get them to stop doing things.
In May, a systematic review in JAMA Pediatrics looked at the medical literature related to overuse in pediatric care published in 2016. The articles were ranked by the quality of methods; the magnitude of potential harm to patients from overuse; and the potential number of children that might be harmed.
In 2016 alone, studies were published that showed that we still recommend that children consume commercial rehydration drinks (like Pedialyte), which cost more, when their drink of choice would do. We give antidepressants to children too often. We induce deliveries too early, instead of waiting for labor to kick in naturally, which is associated with developmental issues in children born that way. We get X-rays of ankles looking for injuries we almost never find. And although there’s almost no evidence that hydrolyzed formulas do anything to prevent allergic or autoimmune disease, they’re still recommended in many guidelines.