Overkill - Care We Can’t Afford

Dr. Atul Gwande is an accomplished surgeon in Boston.  Unlike most highly successful surgeons, he is a health researcher and policy wonk.  I have been reading Dr. Gwande’s books and articles since 2010 when I retrained in health information technology under the Affordable Care Act.  His work is always inspiring but his latest article ““Overkill” in The New Yorker (http://www.newyorker.com/magazine/2015/05/11/overkill-atul-gawande) is his most profound work that can change how and when a senior citizen spend their money.


 “Low value care but really was no value care” said Dr. Gwande.   Doctors take The Hippocratic oath to “do no harm” but whose definition of harm are we using?   Dr. Gwande articulates the harm the US health system is doing by over testing and over treating.   Medicare spends the largest portion of a senior’s benefits in the last year of life.  The cost takes a huge bite out of the fixed income of seniors for medications, insurance copayments and deductibles that would otherwise pay for life sustaining food, housing, clothing and other daily expenses. 



Waste and overtreatment are costing people their lives. Dr. Gwande tells a story of a physician who considered a surgery a “success” though it left the elderly man severely disabled from stroking out in surgery then confined to a nursing home.  How many of us want chemo and radiation for our last weeks of life?  Who would volunteer to get a pacemaker when the decades of heart disease have eroded this vital muscle?  Who wants to live on multiple painkillers and steroids in their eighth and ninth decades of life? 


Learn to use Dr. Google to make wise and cost-effective decisions before scheduling a procedure.  Dr. Gwande outlines a study he conducted on a Texas city with some of the highest Medicare costs in the nation.  His work shined a very bright light on the problem.  Physicians and hospitals are over using new technologies and service that they owned. His study is a caution to all of us.  The days of “Marcus Welby, MD” and the notion of ‘doctor knows best’ have passed.  The internet is the great equalizer so that each one of us can read and weigh the risks and benefits for ourselves. 


Build a partnership with your primary care physician.  Dr. Gwande calls the family physician-patient relationship the “hub and wheel of the health care system.”  Health care reform is incentivizing physicians to keep us healthy.  Primary care physicians are your advocates in our complex healthcare system.  When a Specialist, who looks at one organ or system, recommends a procedure, turn to your primary care physician to see the whole picture.  REUNIONCare is your partner in building this new relationship with your physician.  We are changing the way we care for each other.


Monica Stynchula, MSW, MPH

JR KeeneComment