Dr Robert Dubois Explains Challenges in Addressing Low-Value Services
We live in a society in the United States where more is better, so why would we think that when we go to the doctor that our attitude would be different, said Dr Robert Dubois, MD, PhD, chief science officer and executive vice president, National Pharmaceutical Council.
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What challenges are there in addressing low-value services and their effect on healthcare spending?
I think there, for decades, has been an awareness, but there is in fact low-value care. The RAND corporation back in the 80s identified 20/30% of all major procedures they looked at – hysterectomy, back surgery, whatever – were unnecessary, where the risks outweighed the benefits.
The Institute of Medicine, now the National Academy of Medicine, identified that there is $700 billion of low-value care and waste in the system. Health Affairs recently published an article showing that we haven’t made much of a dent in all of this. We absolutely need to do a better job.
The problem is, I believe, 2-fold. The first is, there’s very little no-value care. If you have a headache and you want to have an MRI scan to rule out a brain tumor or an aneurism, it’s not high value, but it’s also not no value. So, the real struggle is with the stuff that’s in the middle, the stuff that has some value, but the costs associated with it are really not commensurate with the benefits.
The second issue is, and I think this is really the more fundamental one, is we live in a society in the United States where more is better. More cable channels, much better than fewer cable channels. More bandwidth on the internet, clearly better. More followers on Facebook, clearly better. Why would we think then when we go to the doctor that your attitude would be different. There is a cultural expectation that if you do more, that’s better than if you do less, and that’s really the issue we really need to begin to talk about.
To get to a point where if you go to the doctor and the doctor says, “You know, you have a virus, you feel rotten, but you don’t need a chest X-ray, and you don’t need antibiotics,” and the patient leaves the doctor’s office feeling good about it: “Great, I don’t need stuff. In fact, this will go away, and I will get better.” The reassurance is sufficient.
We need to move away from a world where more just always feels like better to a world where that isn’t the case. What we need is the high-value stuff and begin to push aside all of the other.