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Sep 19, 2014

Is more better? Sometimes, but not always in healthcare

We tend to live in a society that has the mindset of “if a little is good, more must be better.” I subscribe to that theory for a lot of things (time spent with good friends, laughing, pizza, etc.), but when dealing with healthcare treatment, more isn’t necessarily better. I often give the example of Tylenol. If you have an ache, a couple of Tylenol may give you some relief. If you take 40 Tylenol, you’re most likely going to end up in the hospital, or worse.

Going by this mindset for treatment in my office, I am acutely aware of how many times and how aggressively I should be treating someone for a given injury. For example, a 30 year old male comes in with extreme low back pain, hurts when they cough, pain going down the back of the leg. Before even going through a physical exam, my intial thought is lumbar disc bulge. The typical patient in my office with a recent onset of this pain generally has a 90% reduction in symptoms within 6 treatments (3 treatments per week over 2 weeks). Assuming a normal progression of improvement, I am generally releasing a patient from a plan of care following a two week treatment period. I have found that treating people longer doesn’t necessarily provide more relief, and sometimes treating more frequently causes symptoms to be prolonged.

Another disadvantage of over-treating in healthcare is in terms of cost. The more you treat, the more the cost of healthcare, for the patients as well as the insurance company (which in the end is passed along to the patient in the form of increased premiums and decreased co-pays, etc). And this includes all treatment (chiropractic, massage, physical therapy, medication, imaging, etc.). In the above lumbar disc bulge example, if the patient hadn’t improved within 6 treatments, a prudent measure would be to refer out for an MRI of the lumbar spine. Ordering a lumbar spine at the beginning of treatment is not the standard of care for a differential diagnosis of a lumbar disc bulge. And in fact, the vast majority of lumbar disc bulge cases resolve without the need for expensive testing such as an MRI. In the end, the less testing and treatment you need, the more cost effective the solution becomes, for everyone involved.

So, in the end, a patient, as well as a physician, should be asking, “is this the most beneficial way to treat this condition?” And by beneficial I mean, fastest, most effective, and most cost efficient. No one wants to be injured or sick. We as physicians owe it to our patients, as well as to our profession, to deliver the most effective and cost efficient means of treatment available. And sometimes that means having a less-is-more approach.

And with that, I wish everyone out there a safe and healthy week.