Technology and Health Care Costs

by Hayden Hollingsworth

Is there such a thing as too much technology?  I’m about to release my Inner Curmudgeon but it’s something to ponder.

In the last hundred years we have seen an unmatched explosion in technology.  More has been discovered/developed/invented in that time frame than the rest of recorded history combined.

Everyone would agree that civilization has been immensely enriched by it but little attention is paid to the unintended consequences of all those innovations.  One could write a doctoral dissertation on that and still leave vast areas unexplored.

There is one realm in which most will have an encounter with the highest type of technology—a trip to the hospital.  My career as a cardiologist spans decades in which I have seen advancements that are mind-boggling.  Because of it countless lives have been saved and health improved for millions.  No sensible person would suggest that we go back to the days before modern medicine.  A sensible person might, however, suggest just because a medical technology exists doesn’t mandate its use in every case.

There was a time when a visit to the doctor or a trip to the emergency room was relatively straightforward:  What could be done was done and often it wasn’t much.  Today that is no longer the situation.

The recount of the following is not an actual case but an amalgam of a number of medical events of which I have knowledge.  A person going to an emergency room will encounter, and quite properly, a nurse or technician who will assess the severity of the problem; it’s called triage and separates those who need instant attention from those with less serious problems.  For example, chest pain needs merits a thorough evaluation.  That will include blood tests, numerous EKGs, monitoring of heart rhythm, continuous measuring oxygenation of the blood, and some type of stress test usually involving isotopic or ultrasound scans.  It may well lead to cardiac catheterization, a test that is performed for thousands of patients a year in any large hospital.  If one has blocked arteries this may lead to life-saving procedures that were unthinkable until recent years.  That’s a wonderful use of technology and medical skill, to be sure.

What is missing in that scenario is the mention that the patient is known to have heartburn, did not take his medications that morning, and had a jalapeno pizza and three glasses of red wine for dinner.  All the tests will be done  . . .  and they all will be normal.  The patient and the family will be relieved that there is no heart problem.  The hospital will have applied all the technology available and the bill will be more than $20,000.  Of course, the actual amount the insurance will cover may be less than a tenth of that, an economic anomaly that even the hospital financial officer cannot explain.

Those treating the patient had never seen him before and will never see the person again.  Of the multiple physicians involved, some are located in Australia or India where scans are interpreted by contract physicians because local radiologists are not available at night.  Because of this fragmentation of care no one feels comfortable in applying what physicians of my generation called “clinical judgment.”  No one wants to take the responsibility of saying the obvious:  “Here’s some antacid. With your stomach problems, be careful what you eat.”

The questions answered by the technology protect the physicians and the hospital from the malpractice suits.   The standard of care seems to be to do all the tests to cover all the possibilities.  Perhaps that is the correct stance but it is one of the factors in the astronomical costs of medical care.  Technology too often replaces asking a few questions and careful physical examination.

If there is an answer to this conundrum, it will not be a simple one.  Maybe someone will develop technology that gives good judgment a rebirth.  Good luck on that!

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