Jack Wennberg found that in the city of Lewiston, Maine, an overwhelming number of women were having hysterectomies. And, unlike apparently everyone else, he found this weird:
In a piece off-puttingly titled "The Tell-Tale Womb of Lewiston, Maine," NPR talks about the "eureka" moment (or, you know, the bad equivalent) for Dr. Jack Wennberg, whose work has become an important cornerstone of the healthcare-reform debate. In the 1960s, charged with bringing modern methods to isolated New England communities, Wennberg started examining the existing practices, studying every medical record in the state of Vermont. What he found was shocking and bizarre: in some towns everyone had their hemorrhoids removed, in the next town, not; in one town 3/4 of the kids were missing tonsils, while just down the road their neighbors' were in tact. As to Lewiston's hysterectomy mania, well, Wennberg quickly deduced that it was not, as people had always assumed, because the largely Catholic community had more children than others. Rather, it was all the doctors, and it was arbitrary. So Wennberg started getting doctors together and talking with them.
One reason some doctors mentioned was fear of lawsuits; some worried that if they didn't do every possible thing they might get sued. Another reason was temperament - some doctors were clearly just more eager to take action than others....Then there was the role of local medical culture. For example, even though it didn't make sense and wasted a lot of time and money, pediatricians in some communities felt they absolutely positively had to send even mildly sick kids to the hospital.
Doctors were also affected by "peer pressure" from other practices, and, the elephant in the room, money. Simply put, if you do more, you charge more. More procedures, more complexity, is more lucrative. It is not always, surely, malevolent - and generally it doesn't seem, from the piece, like it's doing (overt) "harm" - but it's also true that this may affect why some procedures become industry standard while older ones are phased out. That, and our appetite for innovation and the mind-set that complicated is good - and expensive is good. What's funny about the findings is that wealthier patients - although they got more care - were not necessarily living any longer. Explains the piece,
This is probably because of a something called fragmentation of care. In high-use areas, it's often the case that many different doctors play a role in the care of a patient; many specialists are responsible for overseeing only a small part of the person. This increases the amount of treatments, tests and hospitalizations that people get, and exposes people to more risk of harm from medical error and side effects.
NPR concludes "the United States spends more than $2 trillion on health care every year. So the cost of that 30 percent unnecessary care annually? $660 billion." This is black-and-white and inarguable. But Surely within that there's plenty of gray - the forementioned community expectations, that'll be a major overhaul, plus the fact that an "unnecessary procedure" that brings comfort to a dying person or his family is a trickier matter than a wholly gratuitous hysterectomy. And the role of malpractice reform, only mentioned in passing here, seems important: if in fact fear of lawsuit and untenable insurance policies are pushing doctors to do more - to do everything - rather than an intuitive safer "less," it seems like an unavoidable piece of the puzzle. The upshot (besides the fact that, yes, we really need some health-care reform)? Second opinions, people. Ideally? Over the town line.