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ADVANCES IN HEALTH CARE ARE NOT ALL ABOUT GLITTER AND EXPENSE

 

August 18, 2017



On August 1st there was a front page article in the Denver Post with the heading “U.S. hospitals set record for fast heart attack care.” This referred to opening up an acutely clogged artery with a stent, fast enough to save heart muscle and lives. This of course is good news, because heart attacks are the main cause of death in America. And we’re fortunate that our local hospital, Valley View, has this capability.

However, this high tech solution is an example of how, in modern American society, people are looking for sexy, expensive, headline-grabbing technology to solve their health problems. At least 25 percent of heart attack (myocardial infarction) victims die suddenly, before they can dial 911. The good news is that almost all heart attacks can be prevented. If patients take personal responsibility for their health by exercising and eating an optimal diet, and if primary care physicians do their job, there should be no need for stents. Furthermore, lifestyle modification is cheap and doesn’t have side effects. But this approach isn’t sexy and doesn’t get much press, or much attention in medical school.

We hear about genomics eventually being the answer to many health problems. However, as Robert Pearl, M.D., in his book “Mistreated” says, the promise of genomic medicine has yet to be fulfilled, and probably won’t be for years, if ever. He notes that “everyone would be better off eating healthier foods, exercising regularly, and getting the appropriate prevention screenings.” He also points out that “extending the full benefits of immunization to every person worldwide by 2020 would prevent an estimated 20 million deaths—mostly in children—and untold suffering from blindness, paralysis, and deafness for millions more.”

A recent health tip column talked about robotic prostate surgery. The robots cost $1 million, robotic surgery takes longer than conventional surgery and patient outcomes are no better than with traditional surgery. However, due to marketing, patients think robotic surgery is the way to go, so hospitals buy this expensive technology and urologist use it.

Seatbelts are low tech and inexpensive, but save more than 15,000 lives every year in the U.S.

One of the greatest advances in health care in the last 100 years was improving the way doctors organize their thoughts and medical records when they see patients. When I was in medical school in the 1960s, a patient would come in with say hypertension, diabetes, back pain, and a cold. The note would often intermingle all the problems in one paragraph, with no clear diagnosis or plan for each problem. In the late 1960s, Dr. Lawrence Weed, at the University of Vermont, changed this with the problem oriented medical record and SOAP notes. SOAP is an acronym for subjective complaints (what the patient tells the doctor); objective (what the doctor finds on exam and lab and other studies); assessment (what the doctor thinks the diagnosis is including other possibilities); and plan (what the doctor’s plan of treatment is). Each patient record now has a list of the permanent problems such as hypertension, diabetes, chronic back pain, and a SOAP note should be done for each problem a patients presents with at a particular visit. This forces doctors to think in a logical fashion about each problem. This simple, low-tech approach, standardized doctors’ practices and record keeping, and improved quality of care immensely.

The point is that when it comes to health care, all the glitters is not gold, and some of the most important medical advances in modern medicine have been inexpensive and low-tech.

 

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