The Cavalcade of Risk is up at Workers’ Comp Insider, hosted by Julie Ferguson. It includes a great article by David Williams about a hospital that has been able to reduce their use of CT scans on kids with head injuries. The hospital changed their protocol to reduce the number of kids who were getting more than one CT scan following a head injury. The change did not impact the treatment outcomes for the kids involved, but it did lower the incidence of CT scans (which means lower risk of future radiation-linked cancer), reduce the total time the kids spent in the hospital, and lowered their average hospital bill from $24,000 to $14,000. That’s a significant improvement in every regard, and hopefully the same protocol will be adopted at other hospitals around the country, and encouraged by health insurance carriers.
David mentioned that “…ideologues would call this rationing.” I couldn’t agree more, and I think that research like this is the best defense against those who criticize any sort of evidence-based medicine that results in less treatment – but better or equally good outcomes. The word rationing has a bit of a negative connotation in our culture. It conjures up images of people standing in line for hours to get a loaf of bread, or only being allowed to buy five gallons of gasoline at the pump. It makes us think of hardship and having to do without things that we need. I believe that people who are opposed to scientific, evidence-based medicine are capitalizing on the public’s general dislike of the concept of rationing in order to make it sound like evidence-based medicine that results in less treatment is something to be feared. It’s not rationing to opt for fewer CT scans if the same level of patient care can be accomplished either way. Things like radiation and prescription drugs all have side effects, some of which can be very serious. If patients can be treated just as well with fewer scans, or fewer drugs, that is the sensible thing to do. It’s not rationing in the traditional sense of the word. It’s looking out for the best interest of the patient (in terms of avoiding side effects) and the health care system in general (which needs to reign in costs in order to survive).
Of course, any time we use evidence-based medicine to set a new standard that requires less treatment or intervention, not everyone is a winner. Providers who are paid on a per-procedure basis, pharmaceutical companies, and medical equipment manufacturers do stand to lose money if patients end up needing less care. But the cost of health care is rapidly becoming unsustainable, and all of those entities stand to lose if the country eventually pulls the plug on market-based health care and switches to a single-payer type of system. So really, evidence-based medicine is in everyone’s long-term best interests.