A Small Dissertation on Healthcare
A Small Dissertation on Healthcare By Robert Knutzen, MBA, CEO Pituitary Network Association The healthcare component of the American dream is in shambles. Even those who have health insurance through their employers, unions or their own savings or insurance are not well served. They often complain bitterly of drastically increasing costs and spotty or non-existent access to the latest diagnostic tools and the best treatment options. It is my belief that the medical system suffers from the same disorder that society chafes under: information overload. Untold amounts of unapplied knowledge exists in a mosaic of information that is so far beyond man’s ability to read, absorb, store, retrieve and utilize, that it is effectively out of reach, even for the most sophisticated person.
Hence, it is also out of reach for everyone who rails against or despairs in the current medical system. A solution to the problem exists in computer science. What we need is a Web site that presents a comprehensive picture of everything we know about medicine today. Let doctors reach for the information in one place, and put it to use. Only a superb computerized program can solve the problem and put all the options on the table for all to see. The World Health Organization, the National Institutes of Health and a partnership of universities, pharmaceutical companies and a giant in the computer industry (such as Sun, Microsoft, IBM, etc.) could launch a service paid for by mandatory fees from insurance companies and others. The American Medical Association, in a recent edition of the Journal of the American Medical Association, released a study showing that nearly 50 percent of Americans go un- or under-diagnosed, even with well-known and often fatal diseases. The study found that, as a result, patients are clearly un- or under-treated for the very same problems, in the same numbers. The New England Journal of Medicine, in an article published on March 16, 2006, asked the question, “Who is at greatest risk for receiving poor-quality healthcare?” The study’s authors are from respected institutions: RAND Health, UCLA, the University of Michigan, UC Irvine, various veterans’ affairs centers, etc. This is the second article written by these team members.
The first article is entitled “Landmark study finds American adults often fail to get recommended care, posing serious threats to health.” (NEJM, June 26, 2003). Both articles do justice to the problem by pointing out the failures of the present system, yet they offer no solutions. According to the 2003 study, people with colorectal cancer, for instance, only received 54 percent of the care they needed. Patients with diabetes received only 45 percent and pneumonia patients only received just 39 percent of recommended care. The figures in the most recent study are startling.
Researchers found that 56.6 percent of patients who are welloff (earning more than over $50,000 income) received sub-par care, compared to 53 percent of those earning less than $15,000. “The differences among socio-demographic subgroups in the observed quality of healthcare are small in comparison with the gap for each subgroup between observed and desirable quality of healthcare,” the authors of concluded. “Quality improvement programs that focus solely on reducing disparities among socio-demographic subgroups may miss larger opportunities to improve care.” Political candidates, union leaders, community activists, civic leaders and the media frequently assail America’s healthcare system, claiming it has failed. These same people are happy to throw additional billions of dollars at the issue, apparently thinking that more money makes for good medicine. Ironically, this group has attempted to improve medical care by using the legal system to extract money from the imperfect system.
John Steinbeck, in his 1952 novel “East of Eden,” condensed the issue succinctly when recalling the words of one of the book’s characters; “. old Sam Hamilton saw this coming. He said there couldn’t be any more universal philosophers. The weight of knowledge is too great for one mind to absorb. He saw a time when one man would know only one little fragment, but he would know it well.” That brings us to the issue at hand. The “philosophers” are today’s medical researchers, scientists and clinicians. Thousands of them hold the keys to a treasure trove of knowledge about medical care, yet this knowledge is not applied to the problem because our faith in our fellow scientists’ and citizens’ memories overshadows some simple facts. Neither the National Institutes of Health (nor anyone else) has looked at the big picture. The NIH Web site is a worthy effort, but it presents information in small segmented pictures geared to the academic community. However, average clinicians (not academics) are the first to actually see patients, and they sometimes have no idea what they are looking at. If you go into any doctor’s office today you’ll see stacks of journals on every issue pertaining to that doctor’s specialty. But what if his or her specialty is cardiology and the next patient has a gastrointestinal problem? The symptoms often look alike? Where does the doctor turn? A solution to the problem exists, but again in an under-utilized and misunderstood mode: computer science.
The solution is simple to start and could readily be fleshed out. Hundreds of computer companies can be found in the Silicon Valley in California, in close proximity to some of the nation’s largest bioscience universities and medical research facilities. Those companies employ brilliant and well-trained individuals who could lead the world by developing programs to facilitate up-to-date, cost efficient and easily applied medical care. The end result would hugely reduce the cost of healthcare. This large, searchable Web network could include and cross-reference all pertinent and scientifically accepted medical diagnostic and treatment options. For example, optometrists too often do not know that vision failure is a common symptom of pituitary tumors. Family practitioners and Ob/Gyn’s too often do not realize that polycystic ovaries syndrome is an endocrine disorder. Symptoms include hirsutism (excess facial and body hair growth) and acne or skin rashes. Sadly, the problem is too often treated with an unneeded and costly hysterectomy. Colon and rectal cancers often stem from an over-secretion of growth hormone which causes colorectal polyps that can turn cancerous. High blood pressure, an enlarged heart, and a propensity toward stroke and heart failure develop early in many pituitary/hormonal patients, but only the endocrinologists seem to know this. Cardiologists do not, in my experience, spend any time learning most or any aspects of endocrinology.
They are therefore woefully unprepared to deal with cardiac failures in hormonal patients. Patients often suffer costly fertility treatments and sexual failures because they are misdiagnosed. Please understand I am only giving a few first-hand examples as I have observed the situation since founding the Pituitary Network Association 17 years ago. Each sub-set of patients I have met has their own stories of missed diagnosis, repetitive testing, improperly applied or outdated treatment protocols and the always resultant high cost and dissatisfaction with the system. Too often they search for alternative methods where none exist. A cross referenced network of all known disorders, with their symptoms and diagnosis, appropriate tests, laboratories and available treatment centers is sorely needed. As Certified Medical Education credits are mandatory for virtually all medical practitioners, so must “computer medical resources” be included on the list of mandatory courses. The issue to be addressed is not an overthrow of the medical system but instead a systematic improvement and dramatic change. This would allow for a better, more effective use of a medical system that is already superb, but overburdened. It is axiomatic that healthcare insurers should be required to utilize the system, as will every health care provider.
However there should be no need to decertify or exclude any legitimate user, nor should there be a need to force physicians to leave an insurance provider network or HMO. The goal must be to streamline and simplify the information pipeline so as to reduce repetitive doctor visits by patients seeking a diagnosis or correct medical care. In addition, this should almost certainly lead to a drastic reduction in unnecessary surgeries and procedures that are now often used prophylactically to ensure that all steps are taken to reduce or eliminate all known health risks. Doctors often do not realize that the cure can be worse than the illness. Further, the new network should reduce the dependency on unneeded and over-prescribed medications, which would further reduce costs, especially for Medicare. div > .uk-panel’>” data-uk-grid-margin> Available Now!
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