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Minimalism in medicine

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The next time you go to your doctor for a procedure, ask them what their outcomes are beyond 10 years. (Courtesy photo)
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Minimizing surgical and hospitalization time has been a cost-effective and welcome trend in both medicine and surgery. Gone are the days when patients routinely spent days in the hospital after delivering babies, undergoing heart surgery or having joint replacement. Hospitals are now basically acute care facilities, sending out patients who need longer stays to secondary facilities. Rehab and physical therapy visits have been cut to the bone. So what’s not to like?

Results: The lack of them. The quality of medical care is now measured mostly by the cost of caring for the patient and by low return or readmission rates to hospitals. The lower the cost, the better — and if the patient doesn’t come back, they must be cured, right?

Wrong.

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What is lost in this equation is an assessment of the quality of the “cure.” If a patient gets a total knee replacement and does not come back, the surgeon and hospital get an “A” grade. But what about the patient who lives with pain and doesn’t complain? Or the patient whose knee doesn’t get back to full motion? Or the patient’s whose knee is loose and mildly unstable? Or the patient who continues to limp? Worse still, what about the patient whose knee replacement fails after the one-year “final” assessment?

The point is that outcome measures that accurately demonstrate the quality of surgical care are neither standardized nor required — and are simply not being collected in the vast majority of cases. And this is in an era where we quantify everything about ourselves with Fitbits, food scales and smartphones. So why do we not include this crucial data?

There are several answers. First, it is not required (partly because data collection was difficult in the past). Surgeons are not trained well or compensated for collecting outcome measures. The insurance companies, meanwhile, have only short term goals so the costs of any failures are someone else’s problems.

First, the tools for collecting outcomes are now online and in the cloud and are becoming easier and cheaper for both doctors and patients to use. Next, since all patients now have smart phones and almost no one changes their cellphone number, it’s possible to create an app or a text messaging tool that reaches out to every patient — monthly at first, then annually — to follow up and collect validated outcome measurements. By effectively crowdsourcing the outcomes of all implants or procedures, we would get a far better idea how well our healthcare system works.

So the next time you go to your doctor for a procedure, ask them what their outcomes are beyond 10 years — and ask how they know the answer to that question. If they don’t know (and most don’t), ask them to start collecting the needed information so you can contribute your own experience to the knowledge base. Best of all, neither the doctor nor the healthcare system will be able to forget about you.

Dr. Kevin R. Stone is an orthopedic surgeon at The Stone Clinic and chairman of the Stone Research Foundation in San Francisco.

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