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Musings: Blog of the JAAPA Editorial Board


Blog of the JAAPA editorial board.

Monday, April 7, 2014

Advocating for right care
Brian T. Maurer, PA-C
On the advice of a colleague I read with interest the Declaration of Right Care posted at the Lown Institute website. In essence, right care refers to the delivery of appropriate medical care for all patients, particularly for individual patients in whatever set of circumstances they happen to find themselves.
A basic tenet of right care is doing what is best for the patient. Proponents of right care recognize that our contemporary healthcare system encourages the overuse of care for the well-to-do at the expense of those less fortunate, who tend to receive less care than they need.
Under our traditional fee-for-service system, visits to the doctor, laboratory tests, imaging studies, surgeries, and other procedures are encouraged, because of the simple fact that each one of these actions channels more revenue into the coffers of clinicians. Put simply, modern medical practice is a big business, where the commodity of healthcare is bought and sold. Profit maximization is the mantra of the day.
Patients buy into the system as well. Driven by fear, anxiety, and other intangible needs, patients seek out the services of clinicians, many of whom are only too happy to oblige the customer by selling every available product. Service with a smile. Seemingly, everyone benefits, with the possible exception of the poor insurance industry, which must part with some of the ill-gotten gain every time a medical claim is filed. But it too has stopgaps in place to insure its own survival in the lucrative medical marketplace.
The only thing wrong with this model is that it’s broken; and if allowed to continue in its broken state, is highly likely to break the collective economic bank.
How do we ratchet back healthcare expenditures while continuing to meet the healthcare needs of the general public?
When it comes to ordering tests and performing diagnostic procedures, clinicians could learn to become more discreet. They could resort to spending a bit more time with individual patients, taking appropriate medical histories and performing directed physical examinations. They might resort to watchful waiting as a bona fide medical intervention, which actually works much of the time.
Not every headache warrants an MRI of the brain; not every concussion requires a CT scan of the head; not every complaint of chest discomfort mandates an ECG or echocardiogram—much in the same way that not every runny nose requires an antihistamine, not every sore throat requires a course of antibiotics, and not every cough requires a metered dose inhaler.
Along the same line, not every bereaved patient needs an antidepressant; not every upset stomach needs a proton pump inhibitor; not every sprained ankle requires a radiograph.
If more clinicians opted to deliver right care instead of defensive care, more financial resources might be left in the collective pot to fund appropriate healthcare for those whoh need it most: the poor, the destitute, the uneducated, and the disenfranchised.
Instead of performing every possible procedure and treatment to prolong the lives of the terminally ill, perhaps as a society we could agree to pool our resources to better the lives of as many of our fellow human beings as possible, regardless of their age or station in life.
But if that were the case, the present house of cards would surely collapse; few would make fabulous salaries, and our precious technological wonders would lie in waste, obsolete ahead of their time.
Brian T. Maurer practices at Pediatric Walk-In Care in Enfield, Conn He is the author of Patients Are a Virtue and blogs at The views expressed in this blog post are those of the author and may not reflect AAPA policies.