Time to wake up those in charge of fixing healthcare, let young providers get their rest
Notes on the news:
- Some recent newspaper stories show that in addition to achieving universal or near-universal health coverage, a lot of policymakers are becoming increasingly concerned about medical costs.
The Washington Post reported what most people in the industry already know: The U.S. spends enormous amounts on healthcare and gets nowhere near its money’s worth. But readers from outside the industry might have been surprised by some of the people quoted in the story as supporting that thesis. They included Denis Cortese, president and chief executive officer of the Mayo Clinic; Gary Kaplan, chairman and CEO of Virginia Mason Medical Center in Seattle; and George Halvorson, chairman and CEO of Kaiser Foundation Health Plan and Hospitals.
The story also quoted the usual political pooh-bahs, such as Sens. Max Baucus (D-Mont.) and Chuck Grassley
(R-Iowa) of the Senate Finance Committee, as warning that expanding coverage will cost serious money. Hence, the rising concern about cutting the waste.
Another story in the New York Times illustrated the difficulty of trimming costs. It recounted the headlines made in late 2002, when a large clinical trial concluded that dirt-cheap diuretics worked better than expensive new drugs at controlling blood pressure. The findings held the promise of billions in savings.
It didn’t work out that way. The portion of hypertensive patients receiving a diuretic inched up to about 40% the year after the announcement, up from 30% to 35% previously. And the use of newer hypertension drugs grew faster than that of diuretics.
Several factors contributed to the dismal response, including arguments over the trial’s design and interpretation of the results. And, perhaps more than anything, there was major resistance from drug companies and the doctors with whom they are cozy.
Despite the lip service paid to science, too much of what providers do is driven simply by dollars. No clinical trial in the world will stop many doctors from pursuing lucrative treatments. The writer Upton Sinclair put it nicely: “It is difficult to get a man to understand something when his salary depends upon his not understanding it.”
Memo to Sens. Baucus and Grassley: Start devising some tough cost-controls.
- Another explanation for physician reluctance to do the right thing could be long-term sleep deprivation.
The Institute of Medicine last week backed what seems like common sense: more sleep for medical residents. The IOM, which advises Congress on medical issues, said, among other things, that residents should work no more than 16 hours without taking a mandatory five-hour sleep break, and they should get one full day off a week. The report recommended keeping the 80-hour per week limit—averaged over four weeks—on work hours, a restriction that is widely violated. (In comparison, Europe limits its residents to 48 hours a week.)
Speaking of science, study after study has found that lack of sleep impairs judgment and can lead to a host of health problems. Some have concluded that lack of sleep creates the equivalent of a state of mild drunkenness.
Imagine how you would feel on an airplane being piloted by someone who hasn’t slept for 16 hours or is in the 79th hour of his workweek.
But sure enough, after the IOM report some providers equivocated about the seriousness of the issue and whether patients might suffer because of sloppy handoffs at shift changes. Again, not surprising since hospitals have grown used to residents as a cheap source of labor and some doctors favor the system as an old-school rite of passage.
Memo to all members of Congress: Start writing some tough work-hours legislation.
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