The premise of Gawande’s essay is overutilization in hospitals. A lower socioeconomic status (SES) town has similar healthcare expenses to a higher SES town, even if their schools and civil service buildings are drastically different.1. However, there is a massive difference in patient expenses between multiple hospitals. For instance, Gawande found that the Mayo Clinic has lower costs as opposed to a McAllen, Texas and the major differences are patient care and only testing when necessary.1 Doctors have determined there are twenty-six tests that are useless for people who do not exhibit specific symptoms and approximately thirty percent of patients receive one of these tests yearly.2 An example of a useless test would be if a person came in for a migraine, with no history of seizures, and the doctor used a test that is specifically for seizures. While testing for seizures would be valuable for certain settings it should only be prudent when the person has a history or exhibits symptoms of seizures.
I agree that overutilization is the reason for higher healthcare costs. I saw that first hand when I was admitted to the emergency room in New York. I sat next to a woman in the hallway who was in obvious emotional and physical distress. She had been there for hours and was unable to get a diagnosis or treatment because computers with her lab work were malfunctioning. A nurse talked to her and told her she probably had a miscarriage and said they would perform a D&C procedure, which safely removes the baby, and apologized. Two of the goals for health services is to provide patient-centered care and prompt care.3 She could have received a faster diagnosis if the hospital had discussed her symptoms in private setting, and used more than bloodwork as a means of diagnosis.
The field of medicine, specifically around public health, is in the process of contributing more to the utilization of services than it has in the past. It is always going to be difficult because patients feel compelled to accept the judgment of their doctor, even if there is information suggesting the doctor is wrong.4 In order to ensure that hospitals will focus on patient care instead of testing, the patient needs to understand their rights and feel empowered to ask questions. Modern patients are less assertive over their medical care and less likely to ask questions.4 To increase assertion in patients there needs to be more resources on where a person can receive medical care. For instance, the understanding the options of urgent or emergency room is not as readily accessible as it could be, especially when someone does not know the whereabouts of healthcare facilities. These resources will help empower patients. Patient engagement will help decrease over utilization.5 This should decrease the cost of patient care and allow all communities to acquire the proper healthcare.
References
Gwande, A. The cost conundrum. The New York. 2009; 1 June: 35-44 Retrieved from https://www.newyorker.com/magazine/2009/06/01/the-cost-conundrum
Gwande, A. Overkill: An avalanche of unnecessary medical care is harming patients physically and financially. What can we do about it? The New York: 2015; 11 June: 41-46 Retrieved from https://www.newyorker.com/magazine/2015/05/11/overkill-atul-gawande
Steinwachs DM, Hughes RG. Health services research: Scope and significance. In: Hughes RG, ed. Patient safety and quality: An evidence-based handbook for nurses. Rockville (MD): Agency for Healthcare Research and Quality (US); 2008. http://www.ncbi.nlm.nih.gov/books/NBK2660/. Accessed Jun 3, 2018.
Morgan DJ, Brownlee S, Leppin AL, et al. Setting a research agenda for medical overuse. BMJ. 2015;351. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4563792/. Accessed Jun 3, 2018. doi: 10.1136/bmj.h4534.
3. Andersen RS, Vedsted P, Olesen F, Bro F, Søndergaard J. Does the organizational structure of health care systems influence care-seeking decisions? A qualitative analysis of danish cancer patients' reflections on care-seeking. Scandinavian Journal of Primary Health Care. 2011;29(3):144-149. http://www.ncbi.nlm.nih.gov/pubmed/21861597. doi: 10.3109/02813432.2011.585799.