Every therapist can learn a thing or two about pivoting in their practice.
By Jane Brody
If there is a silver lining to the devastation wrought by the coronavirus pandemic, it likely lies in the glaring inadequacies and inefficiencies it exposed that are inherent in traditional American medicine. At the same time, it suggests ways to improve medical practice that can ultimately give us more bang for our health care buck.
The Biden administration currently faces overwhelming challenges to stifle Covid-related disease and deaths, responsibly regrow the economy and curb the environmental and dollar costs of climate change. But as the new president and his team strive to get a handle on these critical issues, they might also confront the myriad failings and needed improvements to health care exposed by the pandemic. We’ve paid too high a price for wasteful procedures and inconsistent medical care delivery in this country. And too many people paid with their lives as a result.
Dr. Robert Steinbrook, an editor at JAMA Internal Medicine, said in an interview, “The pandemic exposed serious vulnerabilities in our health care and created opportunities to solve problems for the long term.”
Although the pandemic prompted many people to miss or delay medical care that sometimes resulted in more serious disease and more costly treatment, it also suggested steps American medicine can take to become less expensive, more efficient and more effective at protecting people’s health.
Exhibit No. 1: Half a century of evidence has documented the health-saving, lifesaving and cost-saving benefits of preventive medicine, yet this country has retained a chaotic, penny-wise-and-pound-foolish medical system that too often puts the treatment cart before the health-promoting horse.
As many experts have told me during decades of medical reporting, we really don’t have health care in this country; we have sickness care. We’re not getting more, we’re simply paying more. The United States spends 25 percent more per person on medical care than any other highly developed country and gets less benefit from it. And the care we get leaves us shamefully behind other developed countries in important health metrics, like maternal and infant mortality and healthy longevity.
“Our system is set up to produce a lot of health care but not necessarily a lot of health,” said Dr. Amol S. Navathe, a health economist at the University of Pennsylvania.
Even the routine annual “wellness visits” covered by Medicare are of minimal value for healthy adults and often result in a cascade of follow-up tests that yield little but cost plenty.
Dr. William H. Shrank of Humana, a national health insurance company, and lead author of a report on waste in the current health care system, said, “We’ve just been through a natural experiment that we can learn from.” Our yearlong battle with a deadly virus suggests ways to improve how medicine is practiced and utilized in the United States to foster better health for its inhabitants.One of the most dramatic examples was the abrupt substitution of telemedicine for in-person visits to the doctor’s office. Although telemedicine technology is decades old, the pandemic demonstrated how convenient and effective it can be for many routine medical problems, Dr. Navathe said.
Telemedicine is more efficient and often just as effective as an office visit. It saves time and effort for patients, especially those with limited mobility or who live in remote places. It lowers administrative costs for doctors and leaves more room in office schedules for patients whose care requires in-person visits.
Even more important, the pandemic could force a reckoning with the environmental and behavioral issues that result increasingly in prominent health risks in this country. We need to stop blaming genetics for every ailment and focus more on preventable causes of poor health like a bad diet and inactivity.
Consider, for example, the health status of those who have been most vulnerable to sickness and death from Covid-19. Aside from advanced age, about which we can do nothing, it’s been people with conditions that are often largely preventable: obesity, Type 2 diabetes, high blood pressure, coronary artery disease and smoking. Yet most physicians are unable to influence the behaviors that foster these health-robbing conditions.
“Many people need help to make better choices for themselves,” Dr. Navathe said. But the professionals who could be most helpful, like dietitians, physical trainers and behavioral counselors, are rarely covered by health insurance. The time is long overdue for Medicare and Medicaid, along with private insurers, to broaden their coverage, which can save both health and money in the long run.
Policy wonks should also pay more attention to widespread environmental risks to health. Too many Americans live in areas where healthful food is limited and prohibitively expensive and where the built environment offers little or no opportunity to exercise safely.
Individuals, too, have a role to play. The pandemic has fostered “an opportunity for patients to take on a more active role in their care,” Dr. Shrank said in an interview.
Covid-based limitations gave prospective patients a chance to consider what procedures they really needed. Most elective surgeries were put on hold when hospitals and medical personnel were overwhelmed with the challenges of caring for a tsunami of patients infected with a deadly virus.
Dr. Shrank suggested that people ask themselves, “How did you do without the procedure?” Maybe you didn’t really need it, at least not now. Maybe instead of costly surgery for a bad back or bum knee, physical therapy, home exercises or self-administered topical remedies could provide enough relief to permit desired activities.
Does every ache and pain require a doctor visit? Short of a catastrophic sign like crushing chest pain or unexplained bleeding, my approach is to wait a week or two to see if a new symptom resolves without medical intervention. I awoke one January morning with pain in my right wrist and forearm so intense I couldn’t brush my teeth. Perhaps I did too much crocheting or slept on it wrong. Ice didn’t help, but I applied an anti-inflammatory ointment, took two naproxen, wrapped my wrist in a brace from the local pharmacy and refrained from crocheting for two days, by which time the pain had resolved.
When professional health care is needed, new approaches have become more acceptable during the pandemic, Dr. Shrank said. Emergency room visits and hospital admissions declined precipitously (though not always wisely by people with symptoms of a heart attack). Noting that many patients can be treated effectively at home by a visiting nurse, Dr. Shrank said, “No one wants to go to the hospital or a rehab facility if there’s a good alternative.”