Lots of news on overuse in the last week or so! Here’s a quick roundup of the important stories you should read:
- Mount Sinai directing elective stent patients through the emergency department: Three reporters for Bloomberg News wrote an in-depth story on several questionable practices reported at Mount Sinai Medical Center in New York City. The most troubling allegation is that patients scheduled for cardiac catheterizations (a kind of heart surgery) were told to come in through the emergency departments. Some patients said they had been coached to say they had the symptoms of acute coronary syndrome. Directing patients through the ER could have induced insurers to pay for some procedures that they wouldn’t have covered otherwise; it could also have increased the hospital’s payment for the procedure, by allowing them to charge the “emergency” cath rate as opposed to the charge for the elective procedure.
The article also notes that Mount Sinai does far more caths than any other hospital in the New York area. Catheterization and stenting are commonly overused – one researcher commented in the article, “It seems unlikely any cath lab could do that many procedures that are all appropriately indicated.
- Surgical checklist produces disappointing results in Ontario: A recent study of the implementation of a surgical checklist in Ontario, Canada found that the checklist mandate had no effect on rates of harmful medical errors or deaths from surgical complications. That’s a huge disappointment, since many previous studies have suggested that the simple act of going through a checklist at a few crucial points in an operation can prevent potentially disastrous errors and complications.
To us, the checklist’s apparent failure in Ontario doesn’t doom it forever, and it doesn’t outweigh the evidence showing that checklists can reduce mortality. Rather, it’s an important reminder that the checklist is just a tool, not a patient safety strategy in itself. To use the tool successfully, surgeons and others have to understand why it’s important – the culture of that particular hospital has to take patient safety seriously. Simply mandating that checklists get used, as Ontario did, doesn’t create the cultural shif that will really protect patients.
- The Incidental Economist has a series of posts on the study that address many of these issues – read this from from Bill Gardner, Aaron Carroll, a response from Atul Gawande (who helped popularize the checklist), and Carroll again.
- New York Times op-ed calls out the importance of social care in improving health: Elizabeth Bradley and Lauren Taylor of Yale’s Global Health Leadership Institute point out that while many other countries spend less than the US on “health care,” they spend proportionately far more on social care, including pensions, housing support, and unemployment benefits. The importance of that spending is borne out in international comparisons of health outcomes, where the US doesn’t seem to be getting much benefit from all the money we dump into medicine.
- Dr. Sandeep Jauhar wonders if we’ve reached the point of diminishing (or vanishing) returns to high-intensity medical interventions like cardiac arrest care. He notes that while medicine advanced rapidly for much of the twentieth century, recent years haven’t yielded the same levels of rapid progress. If he’s right and we’re seeing a long-term slowdown in meaningful innovation, it may be more important to focus on using the treatments we already have the best we can – and not using the new “innovations” that don’t offer any benefits.
- The US spends around $1 billion each year on CT and MRI scans for patients with headaches – even though those scans are usually unnecessary.
- Finally, an industry-funded trial will be looking into whether chocolate can reduce heart attacks, strokes, and heart disease deaths.