The Overuse of Technology in Medical Care

    This is my response for this following article http://healthpolicyandreform.nejm.org/?p=13874 by Dr. Sean Palfrey.

     Sean Palfrey is a pediatrician from Boston University School of Medicine. Spoken from his experience, he pointed out that nowadays practices of medicine rely too much on new technology to over-test and over-treat patients. As an unintended consequence, we are bankrupting our healthcare system. There are several factors why this is happening, but the root of all is our own mind set favor being risk-averse. The doctors who don’t want to be blamed, the patients who believed more medicine is better medicine, the healthcare system that reward financial incentives for the uses of tests, procedures, consultations, and high-cost therapies, and the constrained legal system that pressured practitioners to use “ expensive, and defensive medicine at every turn. We spent a lot on healthcare, but we are ranked “21^st in the world in terms of many indicators of health(?)”

    Palfrey believes that we can rediscover the value of clinical skills and knowledge, and re-educate the society about what is the best practice(s) of medicine. We need to compared the cost-benefit ratios, and research about comparative-effectiveness and long-term benefit analysis of the treatments before implementing them to the cares. We need to integrate new medical technology with care and wisdom from traditional clinical skills, “to bring our healthcare system back into balance.”

     I agree with Dr. Sean that we should not develop dependency on technology, and that we should try our best to minimize the overuse of unnecessary, expensive medical practices, that will actually harming them in the long-term, by education. However, I also have some disagreement with him.

    American’s “not-so-high-rank” health outcome is affected by many different factors (ex:diet), not only because of the overuse of treatments. We also cannot blame the overuse of technology to be the only factors that “bankrupting our system.” I do not believe that people can ignore the possibility of missed diagnosis, or failed treatments, especially when it comes to one’s health and life. We only can minimize, not eliminate. Sean is a 30 years experienced physicians. It’s not fair, and sometime over optimistic, to expect a new graduate doctor, without experience, to trust his clinical knowledge when treating patient. The opportunity cost of taking on his uncertainty is very high. Furthermore, under certain circumstances where time is a limited resource, we cannot be patient on treatments. There is no way to avoid the trade-off between certainty and medicine cost.

     What advanced scientific knowledge and technology can offer is certainty and trust. No one wants to risk his health or life to save some money. How much expectation you have in your health actually comes down to how much healthcare costs your pocket.

---

     This is a real story: a patient come into the hospital’s E.D saying he has a chest pain. His EKG (electrocardiogram) result showed a ST elevation that made the diagnostic doctor to question if it was MI (Myocardial Infarct) or just an artifact. The doctor finally made his decision to give this patient anti-hypertension drug. The patient felt better because he didn’t have to spend much money that night, but also received a “ reasonable treatment” for his pain. He is sent home but died at 3AM in the morning because of heart attack. If only one more enzyme test was taken, he could have been saved by having an emergency cathlab followed.

P/S: Troponin enzyme test cost him about extra $500.