No doubt you've heard the advice “all good things in moderation.” For me, chocolate comes to mind. In the context of healthcare, the expression reminds us that quantity doesn't always translate to quality. That lesson has taken time to learn. Traditionally, as new technologies, interventions, and pharmaceuticals emerged, our healthcare culture was quick to adopt an application and then push utilization. Direct-to-consumer advertising also drove patient expectations and demand while downplaying potential consequences. These strategies worked because they paid the bills. Our system rewarded more healthcare with more revenue—often without a clear connection to patient outcomes.
Times have indeed changed. Patient outcomes and market forces—namely, cost—are driving us to scrutinize past practices and think differently. Though advances in healthcare have saved countless lives and improved quality of life, overuse and misuse has a dark side. Examples include prescribing antibiotics for viral infections at the insistence of the patient or family; the habitual use of radiographic imaging, such as CT scanning, when other modalities may yield suitable information; and performing invasive procedures that may not clearly correlate with improved health outcomes.
The related threats are significant: antibiotic resistance and the emergence of “super bugs,” adverse drug reactions, higher cancer rates from diagnostic radiation, and procedural complications. Given the risks, experts are now reconsidering some longstanding guidelines for low-yield screening studies to avoid the risks linked to false-positive or inconclusive results.
Quite frankly, every patient contact with the healthcare system generates the potential for infection, error, complications, and adverse reactions to well-intended actions. Healthcare risks and benefits need to be placed in context for each individual patient. The clear benefits of rapidly identifying a critical injury in a trauma patient with multiple injuries, for example, far outweigh the radiation risks. However, an abdominal CT scan as a first-line test to evaluate a new onset of vague GI complaints in an otherwise healthy young person just might produce more risk than benefit over the long term.
Our healthcare culture is undergoing a massive transformation—practice guidelines and financial incentives are being aligned with patient outcomes. As nurses, we must stay informed about new evidence-based practice standards. We can help consumers identify high-quality information sources to better navigate their health options. Perhaps most important, we can help consumers understand that more doesn't necessarily mean better.
Until next time—
Linda Laskowski-Jones, MS, RN, ACNS-BC, CEN, FAWM
Editor-in-Chief, Nursing2014 Vice President: Emergency & Trauma Services Christiana Care Health System, Wilmington, Del.