Wednesday, August 8, 2012

Is Less Sometimes More in Healthcare?

Safety has been an important emphasis in healthcare and in nursing in recent years. I believe that an important way to promote safety and prevent harm to patients is to reduce the risk of harm in the first place by avoiding unnecessary healthcare encounters.

We should adopt an approach that always questions the appropriateness of tests and treatments in light of what patients and their families REALLY want and need, looking at the big picture of how these things will benefit the individual in the long run, rather than just protecting the provider and organization from liability. Everything we do costs the patient and family in some way. Sometimes the cost is financial. At other times it is the pain or suffering caused by a procedure or the worry of what a test might find. And always the cost includes time. In some cases, the encounter results in a complication for the individual, the family or both. A complication may be from the procedure itself. It may be a result of being in the healthcare environment. Or the complication may be the long-term financial impact of a decision that we make. I worry particularly about the increased likelihood of complications in individuals, young and old, whose bodies are frail from fighting health problems for a long time, and who are vulnerable to complications that are unlikely in healthy individuals. Are we doing them more harm than good by testing and treating everything?

No test, treatment, procedure or healthcare setting is without some kind of risk, especially for vulnerable individuals, and nothing in US healthcare is free. For many individuals with complex chronic illness, trying to manage their health is a full-time job. Getting to all of the appointments, tests and therapies that have been prescribed by their PCP and various specialists takes a lot of time and effort that often involves family members who have to take off work to get them there and to help them understand and remember and do what they were told when they get home. It's not easy.

Using decision-making practices that focus on the patient and family and that consider the long-term, big-picture risk and benefit, is a good thing. By using this type of approach to care,  safety will improve, healthcare costs will be reduced, and we may even improve people's quality of life.

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