Healthcare in the United States is broken. There are several reasons for this breakdown, most notably the high cost of healthcare spending. As healthcare providers, we often spend more time discussing how insurance costs, healthcare system mergers, and patient non-compliance contribute to these expenses, and less time thinking about the role we play in driving healthcare costs up.
What can we do in the clinical encounter to reduce healthcare costs while staying true to the overarching goal of health equity? Here are two quick ways to target cost and equity at the same time, and they’re easier than you might think.
Step 1: Believe your patients
I recently had a conversation with a colleague about how practicing unevidence-based medicine is leading to overspending in the healthcare system, and I wholeheartedly agree. Most of us follow USPSTF guidelines to decide what preventive measures are appropriate for a particular patient. The guidelines are very clear; However, there are times when we question whether going by the evidence is the right thing to do.
Consider this example: A 35-year-old non-obese non-smoker tells you that she has not been sexually active since her last annual physical. She reports that she has no medical problems but needs a pap smear as her last was about 4 years ago. So what are you ordering?
Answer: Her pap smear and maybe an HIV test (if she hasn’t completed this test, which is recommended at least once after the age of 15).
This may seem obvious to some, but unfortunately I’ve seen vendors add additional STD tests to the pap smear sample in similar scenarios. When asked why, they express concern that the patient might be lying or not remember exactly when she was last sexually active. Aside from the absolute farce of assuming that a patient is lying or that they are unable to recall personal details about their life, it can result in overspending by ordering unnecessary tests. It can also lead to inconclusive results, putting even more strain on the healthcare system and the patient.
Rather than ordering the additional unwarranted test assuming a patient’s character and abilities, consider saving money and improving your doctor-patient relationship by believing your patient and ordering only what is in the patient report and stated in the evidence.
Step 2: Listen to your patients
This may seem rudimentary now, but it is well known that as physicians we are poor listeners. Listening to your patient can lead to earlier diagnosis of a medical disorder, and earlier diagnosis can reduce overall morbidity and mortality in many disease states. Especially in minority patients, earlier diagnosis has the potential to reduce the discrepancy we see in many health outcomes.
Differences in health are often attributed to patient deficits such as financial instability, access to health care or lifestyle choices. But we should also consider the role a provider plays in creating inequalities when we don’t listen fully and address a patient’s concerns during the healthcare visit. Treating symptoms early, before they worsen to the point where acute interventions are needed, could result in reduced emergency room utilization, saving both the healthcare system and the individual patient time and money.
In the tension between evidence-based medicine and the ongoing fight for health equity in the United States, we find two golden rules: Believe your patients. Listen to your patient. On their own, these actions won’t fix our broken system, but they are steps in the right direction to reduce healthcare spending while improving our relationships with patients.
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About dr Jonisha Brown
Jonisha Brown is a faculty member in the Department of Family Medicine at Atrium Health. She received her medical degree from Wake Forest University, Bowman Gray School of Medicine, and continued her residency in family medicine at Carolinas Medical Center, where she also served as an attending. dr Brown received her BS in Psychology and BA in Biology from the University of North Carolina at Charlotte. She enjoys spending time with her husband and two boys, traveling and experiencing cultures through food, talk and entertainment.