Forces of Change from within the Medical Community

I spent last weekend at the Lown Conference in Chicago. For those who do not know about Lown, it would be wise to find out more (www.lowninstitute.org) and to sign their Right Care Alliance declaration. The group is relatively young, and this was my second trip to their annual conference. Just as it was last year, the conference was an enlightening and energizing affair. Being with several hundred people who actually get it—from distinguished academics, to regular docs/nps like me, students, writers, patients, and others touched by the medical field—who understand how our dysfunctional health care delivery system feeds upon and rewards overtreatment, who realize that the information being disseminated by the press, pharmaceutical companies, and many members of the medical establishment is often just plain erroneous and misleading; wow, it makes me feel like change can actually occur.

At Lown I learned a great deal, but even more than that, my own views and research were validated. It is difficult living in the perverse world of American health care and not to be imbued with some self-doubt when so much I know to be true is negated by the actions of my colleagues and is contradicted by the declarations of pundits and the press. Even this week, a day after I was told by our ACO that we did only marginally well on the quality measures that will soon factor into our income (such as our failure to keep LDL cholesterol “low enough” in an aged population, something not demonstrated to have clinical utility and which can cause real harm in elderly folks), I met with a patient who had a stent placed into a heart artery that was blocked only 75%. His only presenting symptom when he met with his cardiologist for a routine visit was a persistent cough, but that was enough to trigger testing and an invasive procedure. The contrast was striking to me, but not unusual. As I am chided for not overtreating geriatric patients and instead caring for them based on their own individual wants and needs, a cardiologist is rewarded for overtreating them. He earns several thousands of dollars and a slap on the back for putting in an unnecessary stent more likely to cause the patient harm than good, and although it costs the system needless health care dollars he does not get a call from his ACO or any recrimination; in fact he is considered a thorough doctor and paid well for his efforts. That is the health care system in which we treat and are treated. The people at Lown know it, and hence it to me is a very powerful instrument of change.

After coming home from Lown I also had the honor of conversing with Nortin Hadler, who is a prolific and well respected professor an UNC and the author of many suburb books on overtreatment and our dysfunctional medical system, including his newest: By the Bedside of the Patient. I had heard him on NPR’s On Point (thanks to Steve Martin from Lown for sending me the link) and reached out to him; we have communicated before, as he was kind enough to review Curing Medicare very favorably. He too is working hard to improve our medical system and to enlighten doctors in training. This is what he said to me at the end of our conversation: “I have no doubt that the current ‘healthcare system’ is unsustainable. Unfortunately it is heading toward an implosion in a cascade of recrimination and vengefulness that will harm patients and the many ethical practitioners who would practice according to their conscience were it not for the perversities of the “institution” we call American medicine. Your voice will be needed come the flood.”

All of our voices are needed, because the flood has arrived, often under the guise of health care reform. Unless those of us who “get it” speak up, question the grand myth that an unending deluge of tests/drugs/treatments will cure our medical ills, and let the media and others who drink the health care Kool-aide know that we are fed up, this system, which enriches so many people and institutions, will persevere until it does implode. That is why you should sign Lown’s Rightcare Declaration at www.rightcaredeclaration.org and should make your wishes known.

What distinguishes the people at Lown, and others like Nortin Hadler, from so many others is that they not only just get it, but are also doing something about it. Nortin Hadler is working to implement a novel system that he thinks will provide a viable alternative to our current health care mess. Many devoted people at Lown are out there working against stacked odds to get things done too. Steve Martin and Wayne Altman and others are using science and reason to discredit current clinical practice guidelines, replacing them with sensible alternatives. John Ioannidis of Stanford, like the researchers at Cochrane (www.cochrane.org), has demonstrated the lack of validity and reproducibility in the vast majority of clinical studies that are published in major journals, and is letting the medical community know. Thomas Cornwell has created an effective home care network that has saved Illinois millions of dollars, and he has convinced politicians and others to help his efforts. This is but a tiny sampling of the many voices in Lown that are trying to stem the flood, and we can thank Lown’s leaders, Shannon Brownley and Vikas Saini, for their tireless efforts at putting this wonderful organization together.

In this blog, as well as in my work with Erik Rifkin striving to improve patient centered care through the dissemination of accurate medical data and our visual aid (www.doc-patient-talk.com), and in my attempt to unite primary care docs and NPs in central Maryland to help trigger local changes in the system (www.primarycareaction.com), I am trying to make my voice known. It is a soft voice, and I am hardly a revolutionary. But many soft voices eventually will be heard. So I implore everyone to heed the tocsin from Nortin Hadler. There is a movement underway to change the system and make it better for all. It is time we all leap on board before the health care system swallows and marginalizes us, as is happening every day.