The Cost of the Doctor’s Pen

“Will that test change your management?”

This question is one of the best pieces of advice I have ever received.  Each time I order a test or write a prescription, I try to ask myself if it will make my patient healthier or feel better.  When I use my high deductible catastrophic insurance plan to see my doctor, I wonder the same thing.  My patients who do not have insurance want to know if the test I order for them is worth the cash they will have to pay on the way out.

•  Routine complete blood count in adults (56% of visits): $32.7 million
• Basic metabolic panel in adults (16%): $10.1 million
• Annual electrocardiogram (ECG) (19%): $16.6 million
• Urinalysis (18%): $3.4 million
• Antibiotics for viral pharyngitis (41%): $116.3 million
• Cough medicines for children (12%) : 10.3 million
• Brand name statins (atorvastatin or rosuvastatin) instead of generic statins (34.6%): $5.8 billion
• Pap smears for patients younger than 21 years (2.9%): $47.7 million
• Bone density (DEXA) scans for women younger than 64 years (1.4%): $527.4 million

We cannot escape the cost of healthcare.  The cost of all those unnecessary little tests add up to $5 billion/year.  As a doctor, I have to take responsibility for the decisions I make daily.  I can think of many better ways to use this money that will save lives or improve our health.

Why not get our money’s worth?

Kale MS, Bishop TF, Federman AD, Keyhani S. “Top 5” lists top $5 billion. Arch Intern Med 2011;171(20):1856-1858.

Is My Heart Healthy?

“Is my heart healthy?” he asked.

After years of frustration, he has decided to tackle his high cholesterol and weight. He came to me as his family doctor to ask for specific advice.

“I’m glad you’re here.  I’d much rather talk to you now, than in the hospital in 5 years.”

I could have spoken for hours, but my advice boiled down to this:

• Eat right
• Exercise
• Don’t smoke
• If you are overweight, lose weight
• Take medicine when needed

If these things were easy to do, I would be out of a job.  Most of us can talk the talk, but the right choice is hard to make when we really want those Buffalo wings dipped in ranch dressing at the Super Bowl party.

My job as a doctor is to help him meet these goals.

1. Eat right: Eat lots of fruits, vegetables, whole grains, fish, poultry, and nuts.  Avoid salt.  Minimize fat.  Fad diets won’t get you there any better than traditional plans like the DASH diet.
2. Exercise: Aerobic exercise like walking, running, biking, and swimming is still one of the best ways to lower your risk of a heart attack.  You should exercise for at least 30 minutes 5 days a week.
3. Don’t smoke: Stopping smoking will cut your risk of a heart attack in half.  I have met few smokers who think smoking is good for them, but quitting is very difficult.  Your doctor can help.
4. If you are overweight, lose weight:  Eating right and exercising will help you lose weight.  Work with your doctor to find the approach which works for you.
5. Take right medicine when you need it:  Medicines cannot replace eating right and exercising, but they can help control your blood pressure and diabetes and improve your cholesterol if bad genes are the cause.

Invest in a healthy future.

Make an appointment with your doctor to talk about your heart health.