Monday, August 3, 2009

Lessons from my Dog

In my article on health reform, I propose that health consumers and providers can save lots of money by making more conservative use of the health system.

Let me illustrate by using my dog as an example. Poor 12-year-old (84 human years) Bandit has been limping around and looking awfully uncomfortable. My family and I recently went on a three day vacation and when I took Bandit to the Vet for boarding I asked her to check out his legs. The next day my cell phone rang and the Vet's assistant told me that they wanted to do some tests. My 'knee-jerk' response was, "Okay."

Upon our return, when I fetched Bandit from boarding, the nice lady behind the counter handed me a bill for over $600, including $300 for x-rays and $185 for lab tests. I asked "why the lab tests?" "That's routine," was the reply. I wasn't quite sure about the x-rays either since we knew that Bandit didn't have any broken bones. "You don't want your dog to suffer, do you?" was the guilt-inducing response.

At any rate, I paid the bill and was given a prescription for an anti-inflammatory that Bandit needed to take for the rest of his life costing $79 per month. I asked about the drug and was told that it was a drug similar to the one that humans take for arthritis and joint inflammation. I asked whether it was like Vioxx, the drug taken off the market by the Food and Drug Administration (FDA). "Yes, this drug is similar to Vioxx," was the response. "Well wasn't Vioxx found to increase the incident of heart attack and stroke in humans?" I inquired. "Yes," was the response. "But, no studies have found this drug to increase those risks in dogs, except there is a higher risk of certain organ diseases."

I then said that I was uncomfortable giving this expensive and dangerous drug to Bandit, and proposed that I give him exercise therapy in our swimming pool to heal his joints, and put him on a lower calorie diet so he could lose some weight, thus taking stress off his joints. The Vet said, "Yes, that is a good approach and may solve, or at least relieve, Bandit's symptoms without medication." I thought to myself, "Hmmmm...why didn't you propose that in the first place?"

For the past two weeks Bandit has done his swimming exercises, rested in the house more, and eaten less food. He is walking much better without any drugs.

We could substitute any of us for Bandit in this story and replace the Vet with any of our physicians who instinctively reach for the prescription pad when a problem is presented. Prescribing drugs is easy and it gets the patient out of the office quickly without the time-consuming, and often frustrating, chore of discussing diet and exercise.

To save billions of dollars in annual national health expenses and thousands of dollars in personal annual out-of-pocket costs, let's establish national standards for the use of drugs and procedures; and educate health consumers to use the health system safely and conservatively. Let's also reward providers for helping patients adopt healthier lifestyles and for using drugs and medical procedures wisely and effectively.


Boomer Bill said...

Bingo, Howard. That's the way most docs/clinics behave based on my anecdotal experiences. Why do they do that?

Howard Veit said...

When the business of medicine clashes with patient care, which it almost always does, $$$$ often wins.

kneecap said...

HI Howard! I didn't realize you were still blogging until I saw your post on the Fuhrman forums. For some reason, your blog doesn't update on my "following list". I even deleted you and added you again and it still says you haven't updated in 3 months. I wonder why that is. Anyway, good to see you still blogging. I'll check in every once in a while manually since the updater isn't working.


Neil Kevin said...

HI Howard! I have read most of your post and found every of it very interesting. Thanks for sharing all this.Keep going

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