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We Can Reduce US Health Care Costs: A Resident's Perspective

      To the Editor:
      I read with interest the commentary by Dalen
      • Dalen J.E.
      We can reduce US health care costs.
      outlining certain key measures that if successfully implemented can reduce US health care costs effectively. I must confess that the author put forth the flaws of the American healthcare system very proficiently. But as a resident physician, I realized that perhaps he missed a point here and that a different perspective may be needed.
      After reading Dalen's article,
      • Dalen J.E.
      We can reduce US health care costs.
      I turned to my 2 fellow residents and a medical student sitting in the residents' lounge and asked if they know how much a magnetic resonance imaging test of the brain would cost. None of them knew!
      Substantial knowledge deficits exist in physicians' understanding of the economic implications of the prescriptions they write and tests they order.
      • Reichert S.
      • Simon T.
      • Halm E.A.
      Physicians' attitudes about prescribing and knowledge of the costs of common medications.
      Despite the spectacular increase in the cost of delivering hospital health care now taking center stage, health economics does not prominently feature in most medical school or postgraduate courses. Medical schools and residency training programs provide little or no formal education about medication costs and insurance coverage of pharmaceuticals and diagnostic tests. Also, there may not be sufficient resources to obtain reliable drug price information in a timely fashion. Cost information is rarely if ever incorporated in medical journals, textbooks, or drug-prescribing guides (including the Physicians' Desk Reference). Our tumbling economy and medical institutions will save millions by educating physicians and students in-training about cost–benefit analyses of diagnostic tests and medications and by seeking to provide them with reliable, easily accessible cost information in real-world practice.
      Another case in point is the dramatic decline in the time spent at a patient's bedside with decreasing interest in obtaining a comprehensive history and physical diagnosis. Profound advances in technology, imaging, and laboratory testing, and our charm for these aspects of patient care have meant that students and residents increasingly approach the patient with little expectation of discovering concrete examination findings. The outcome is a plethora of wasteful and inappropriately ordered tests and consultations. Although less apparent at first glance, the financial burden of not making appropriate bedside evaluation is considerable: The length of stay in the hospital may be unnecessarily lengthened and nonessential, and costly tests or procedures may be ordered. For the joy of a successful doctor–patient relationship and the avoidance of the needless drain of human and medical resources, bedside patient communication and teaching skills of our house-staff should be beefed up.
      The next generation of physicians, practicing under the umbrella of health care reforms, should be taught and trained to function as cost-effective prescribers and able clinicians with thinking minds.

      References

        • Dalen J.E.
        We can reduce US health care costs.
        Am J Med. 2010; 123: 193-194
        • Reichert S.
        • Simon T.
        • Halm E.A.
        Physicians' attitudes about prescribing and knowledge of the costs of common medications.
        Arch Intern Med. 2000; 160: 2799-2803

      Linked Article

      • We Can Reduce US Health Care Costs
        The American Journal of MedicineVol. 123Issue 3
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          The primary reason that the US needs health care reform is that we pay more for health care than any other country in the world; yet our health outcomes are below that of other western nations.1 Our health outcomes are suboptimal because millions of Americans have limited access to ongoing primary and preventive care because they can't afford our health insurance.
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      • The Reply
        The American Journal of MedicineVol. 123Issue 10
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          Dr. Tagela's comments are right on target! The overuse of expensive diagnostic procedures, particularly advanced imaging such as magnetic resonance imaging, computed tomography, and positron emission tomography, is a major contributor to the escalation of health care costs. The Centers for Disease Control and Prevention recently reported that the use of advanced imaging in physician offices and in hospital outpatient departments more than tripled from 1996 to 2007.1 Tageja correctly identified two major causes of the overuse: most physicians are unaware of the charges for various diagnostic tests, and clinicians often order tests after a very brief clinical assessment.
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