The Lown Institute is named after 95-year-old Dr. Bernard Lown, who helped develop the first widely used cardiac defibrillator in the 1950s and founded International Physicians for the Prevention of Nuclear War, which won the Nobel Peace Prize in 1986. The institute in Brookline, Mass., champions his idea that doing as much as possible for the patient can also mean doing as little as possible to the patient. Dr. Vikas Saini, president of the Lown Institute, spoke with Sabriya Rice, who recently left Modern Healthcare to join the Dallas Morning News, about the group's work. The following is an edited transcript.
Modern Healthcare: Do you think most clinicians see overuse as a medical error?
Dr. Vikas Saini: The challenge is in labeling something as unequivocally being overuse. Once you do that, almost all clinicians would say, if they agreed, “Oh, this wasn't necessary.” But the question is harder because labeling something as overuse takes a lot more examination. So much of what we do in healthcare has a very modest, if any, basis in hard scientific evidence. Much of it is opinion. There's nothing wrong with expert opinion. But we shouldn't pretend that it is science the way 2+2=4 is a truth. The majority of care is in a gray zone and that is why it's not straightforward. So getting agreement that something is overuse is the challenge. We need a lot more research; we need a lot more understanding of how these decisions are made; we need a much clearer and better understanding of what the incentive structures are, what the evidence is, and how those can interact. Because so much care is not based on hard science, we have to include and involve patients in the decisionmaking. You can't have right care for the vast majority of what we do unless the patient really understands and not just consents, but understands why and how to move forward with a particular test or procedure.
MH: Can you explain what the term “right care” means?
Saini: Overuse and underuse are often happening in the same city, often in the same hospital, and, amazingly, often in the same patient. You can have an overuse of unnecessary blood tests, technology, X-rays, even unnecessary procedures. And in the same person we can have under use of listening to what their real concern was, why they really came, and addressing that. The term “right care” (means) we have to strive for something that is efficient, affordable, not wasteful, faithful to the patient's own goals and wishes for life and health, and in all of that be aware that our decisionmaking matters, both to the individual patient, and more broadly, to all of us in society.