women's health

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The phrase "high quality, low cost health care" gets thrown around quite a lot these days. Unfortunately, no one seems to be able to agree on what it means. Are there really ways to cut costs and improve the quality of healthcare at the same time, and how do we find them?

A group of doctors from the National Physicians Alliance (NPA) recently listed several common patient problems for which medical care could be improved and costs lowered. Hear are five of the most frequently mentioned areas where less may truly be more:

Sinus Infections
People with mild to moderate acute sinus infection do not generally require antibiotics unless symptoms have lasted more than a week (or if there is worsening after initial improvement).

This one is near to my heart as an infectious disease specialist. Fellow healthcare workers often seem annoyed or hurt when I fail to give them antibiotics in hospital hallways for this problem. (I suspect they quickly slip off to descend on another unsuspecting colleague.) Most new sinusitis episodes are viral infections, and antibiotics are not helpful, though they are prescribed in a clear majority of cases.

EKGs and Heart Disease
Annual electrocardiographs on low risk patients without any symptoms of heart disease are unnecessary. This is another classic case of more is not always better. Routine EKGs are very unlikely to improve health outcomes in such patients, and they can lead to an "off to the races" series of more invasive tests, often with possible serious complications as well as significant costs.

Pap Tests
Screening Pap tests are not necessary in women younger than 21 or in women after hysterectomy performed for reasons other than cancer. Most abnormal tests in adolescent women return to normal spontaneously over time, and such abnormal tests can lead to unnecessary further testing as well as needless anxiety.

Sore Throats
Patients with sore throat (pharyngitis) do not require antibiotics unless they test positive for Strep. Once again, most upper respiratory tract infections are viral, but physicians prescribe antibiotics in a majority of patients with these complaints.

Furthermore, most people with sore throat and no fever, no tender neck lymph nodes, and no white patches on the tonsils should not even be tested for Strep throat. Strep is very unlikely without any of these present.

Low Back Pain
Finally, people with low back pain of less than six weeks' duration should not have routine x-ray or other imaging performed unless they complain of neurological deficits such as weakness or if serious underlying conditions such as cancer or bone infection are suspected. Early screening increases costs without improving outcomes.

Always remember that general rules don't apply to every individual or situation. Be sure to discuss with your physician any unusual details of your problem that may require additional testing.

Each of the scenarios above, however, does offer an opportunity to improve care and control costs. We all can hope that the NPA and other physician groups will continue to look for opportunities to lead in health care reform, keeping patients' welfare first while improving care in this era of limited resources.

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