Sometimes when I write this blog I have the funny punch line in mind before I find the story to highlight it; other times the healthcare story finds me and then I look for the humor in it. This is an example of the former. I have been saving what is one of my all time favorite medical comedy videos from my comedy idols, the Monty Python guys, for when I saw the perfect story. Today is that day. You’re welcome.
I came across an article from yesterday’s Los Angeles Times entitled, “Doctors should learn how to help manage healthcare costs.” in which to Dr. Steven E. Weinberger, chief executive of the American College of Physicians, talks about how physicians, during their residency, should be specifically trained in how to help reduce costs of unnecessary procedures, particularly extra diagnostic tests and other hospital-based interventions. According to Dr. Weinberger, it is not enough to teach physicians medical knowledge and patient care skills; they must learn “how to provide high-quality medical care without breaking the bank.” This assertion would have been considered heresy not long ago, and probably still is in many quarters.
The article cites the what the Institute of Medicine reports as $700 billion a year of wasted medical spending, which comes from unnecessary tests, hospital visits and the like; this amounts to 30 cents of every healthcare dollar. Can you imagine taking 1/3 of your paycheck every month and flushing it down the toilet? That is basically what happens with the more than $2.5 trillion circulating through our healthcare system.
Dr. Weinberger published his complete thoughts on physician responsibility for delivering “high-value, cost-conscious care” in an essay published in Tuesday’s edition of Annals of Internal Medicine. The abstract of his article is as follows:
At present, the 6 general competencies of the Accreditation Council for Graduate Medical Education (ACGME) and the American Board of Medical Specialties (ABMS) that drive residency training place relatively little emphasis on residents’ understanding of the need for stewardship of resources or for practicing in a cost-conscious fashion. Given the importance in today’s health care system, the author proposes that cost-consciousness and stewardship of resources be elevated by the ACGME and the ABMS to the level of a new, seventh general competency.
Dr. Weinberger notes that interns and residents are more likely to get in trouble for underutilizing diagnostic tests and other interventions than overusing them—that they are constantly queried about why they did NOT do something rather than why they bothered to use medical technology or services with minimal or no proven incremental value. According to Dr. Weinberger, “Now that cost control in health care has reached a crisis level, it is essential that we change the culture of the training environment with regard to health care costs. Residents must be thoughtful in ordering diagnostic tests, avoiding the overuse and misuse of imaging studies and laboratory tests that have become rampant in health care. They must avoid duplication of studies and must be conscious of opportunities to prevent avoidable hospitalizations or readmissions. In short, they must become part of the solution to control health care costs.”
This whole discussion was a perfect opportunity for my readers to see the best part of Monty Python’s 1983 movie, The Meaning of Life. Perhaps most well-remembered for its “wafer thin mint” scene, as a person with a 20+ year career thinking about healthcare costs I best remember it for “The Miracle of Birth” scene. In this scene, a woman in labor is ignored by doctors, nurses, and the hospital’s administrator as they drag in more and more elaborate equipment, including, “the machine that goes PING!” which is a device that doctors use to determine if the baby they’re delivering is still alive. It is, according to the movie, “also the most expensive machine in the whole hospital. It cost over ¾ of a million pounds!”
“Aren’t you lucky!?!” they say to the beleaguered patient.
Foreshadowing the ridiculous cost-escalating thinking of some physicians and hospitals that helped contribute to the disaster that is our current healthcare economy, the hospital administrator in this clip, played by the brilliant Michael Palin wearing a tux in the operating room, says, “Aah! I see you have the machine that goes PING. This is my favorite. You see, we lease this back from the company we sold it to, and that way, it comes under the monthly current budget and not the capital account.”
God I love these Monty Python guys. You could put some real doctors and administrators in this clip and it would not be called comedy, it would be called rounds.