Sunday, September 30, 2012

Institute of Medicine Issues Report on Waste in Medicine - Why Whistleblower Readers Should Care?

It was recently discovered that Fareed Zakaria committed plagiarism in an essay he wrote for Time Magazine on gun control.  He confessed and apologized.  I think he could have been fired for this as plagiarism, aka theft, is a cardinal offense for a journalist and a news magazine where trust is a central pillar.  This was not a matter of an indiscretion in his private life or an offense that doesn’t threaten his profession’s central mission. This was dishonesty in a job that should demand honesty in every syllable.  Zakaria is a Harvard graduate and a Yale trustee.  How would these institutions have ruled on a student who admitted committing plagiarism?  CNN and Time ‘suspended’ him.  Was Zakaria too big to fail?

I’ve devoted several posts in this blog to professional integrity and personal ethics.  Medical plagiarism is a serious ethical wound in the medical world and all of us must hold our academic colleagues, medical students and practicing physicians accountable.

In September 2012, the Institute of Medicine (IOM) issued a report that delivered a bold and unexpected message – our health care system is wasting money!  Who knew?  I have to assume that this 18-member panel has plagiarized the Whistleblower as so many posts here are devoted to this issue long before their report was published.  I’ll leave it to readers to decide if I should seek judicial redress on this unethical appropriation.  This is an opportunity for an ordinary reader to become a Whistleblower.


Whistleblower Readers are Watching!


This panel after a year and a half of study concluded that we’re incinerating a ton of money. Lest you accuse me of hyperbole, $750 billion are being vaporized annually, nearly a third of every dollar spent.  How would your personal or professional balance sheet appear if you wasted 30 cents of every dollar?  No business or home can remain solvent under that scenario, and neither can the health care system.
Why are there no checks on this system?  Here are a several reasons why unnecessary care is practiced.
  • Fee-for-service medicine where physicians like me are reimbursed in an a la carte manner.
  • Defensive medicine where physicians like me order unnecessary tests to reduce legal risk.
  • Pressure from patients who desire more testing and treatment believing that more medicine is better medicine.
  • Patients who pursue expensive care of questionable value that they don’t have to pay for.
  • Physicians who practice non-evidenced based medicine.
  • Rising administrative costs.
  • Fraud.
Feel free to add to the list.  Climbing out the hole will be like scaling a glass skyscraper.  Every reform measure angers and threatens a powerful player in the medical arena.  I support initiatives like comparative effectiveness research and the more recent Choose Wisely program, which represent the first steps of what will be a very long odyssey. 

If any blogger has their eye on this post with an aim of posting it as his own, caution.  Whistleblower readers will be watching.



8 comments:

The Medical Contrarian said...

One man's waste is another person's livelihood. As long as we continue to use a payment system which separates those receiving the service from those who have to pay for it, this will continue. When services appear to have no cost, demand for them will be infinite, even if they are not "needed". They will always be wanted.

Michael Kirsch, M.D. said...

@MC,your return to the comment section noted and appreciated. Agree. Ever notice how we order differently at a restaurant when it's someone else's tab?

Gary Levin said...

There is an easy way to avoid plagiarism. Copyscape.com offers an easy means to find out if your copy contains phrases or paragraphs in other articles if the document is on the web anywhere. I have found how easily I can plagiarize, sometimes without thought now that it has become easy to copy and paste.

Michael Kirsch, M.D. said...

Thanks, Gary. There is whole industry now of plagiarism detecting software. Dishonesty has created jobs!

Payam said...

Waste in medicine? And in other news, "No WMD in Iraq." The travesty is not the presence of waste in the medical system, but the blatant lack of initiative to cut waste, not only at the federal/state level, but also the hospital/corporate level. When is the last time anyone from hospital admin approached you as a physician to inquire about cutting waste in the hospital? Even if they were interested, I assure you they would not get a physician involved. When is the last time you were asked, "Dr. Kirsch, we need your help cutting waste in the endo suite." The person making the decision would be a suit incapable of differentiating an endoscope from a screwdriver. I think everyone acknowledges that there is massive waste. What's amazing is the utter contempt for addressing it.

Michael Kirsch, M.D. said...

Payam, spot on! This will change, of course, now that hospitals will be penalized financially for failing to meet various benchmarks.

Mark Faasse said...

Amen to Payam's comment. It seems to me that the IOM is just part of the racket, though. Professing concern, they provide the following summary of where they think money is being wasted:
• Unnecessary Services – $210 billion
• Inefficiency – $130 billion
• Excess administrative costs – $190 billion
• Inappropriately high prices – $105 billion
• Missed prevention opportunities – $55 billion
• Fraud – $75 billion

All of these figures come from a health-care system in which expenses totaled $2.5 trillion in 2009. Only the most conservative definition of "unnecessary services" could arrive at a $210B tab for them (< 10% of the total).

Those who practice medicine thoughtfully understand that the indications for MOST of the care we provide are gray, not black and white. Many of the "problems" we treat aren't really problems at all (but MIGHT become problems in the future) – and many of our expensive "solutions" provide only a small marginal benefit over less costly, more conservative options.

Michael Kirsch, M.D. said...

Mark, you're on to something there.

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