Word: using
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Dates: during 2000-2009
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...Doctors use physical exams and CT scans to identify appendicitis, the infection and inflammation of the small, thin pouch attached to a segment of the large intestine in the lower right abdomen, but often, when the diagnosis is less than clear, they err on the side of caution, recommending surgery - the alternative is to risk a burst appendix, which in fact happens frequently enough while patients wait for test results. According to past studies, somewhere between 3% and 30% of all appendectomies may be in patients who do not actually have appendicitis - conditions often mistaken for appendicitis include constipation, gastroenteritis...
...unnecessary costs are another man's profits; lobbyists for drug- and devicemakers, hospitals, doctors and insurers are already fighting to make sure their slices of the more than $2 trillion health-care pie aren't nibbled by reform. Senate Republicans just introduced "antirationing" legislation to bar the government from using comparative-effectiveness research - "a common tool used by socialized health-care systems" - for cost control. They paused in their usual attacks on Obama's profligacy just long enough to attack his stinginess, warning that he will use evidence as an excuse to micromanage the art of medicine, stifle innovation...
...Mayo also has an institutional obsession with evidence-based medicine, using electronic records for in-house effectiveness research, constantly monitoring its doctors on everything from infection rates to operating times to patient outcomes, minimizing the art of medicine and maximizing the science. "We try to drive out variation wherever we can," says Charles (Mike) Harper, a neurologist who oversees Mayo's clinical practice in Rochester. "Practicing medicine is not the same as building Toyotas, but you can still standardize. Uncertainty shouldn't be an excuse to ignore data." Mayo has teams working on evidence-based protocols to reduce the use...
...Mayo doctors are also shielded from the incentives that discourage evidence-based medicine, because they all receive fixed salaries. They don't make more if they do more to patients, and they don't make less if they take more time to talk to them - even if they use the time to explain why a CT scan or a wonder drug advertised on TV might not be advisable. They don't have to worry about reimbursements that overvalue radiological tests and invasive prostate treatments, undervalue preventive care and watchful waiting and put zero value on returning a phone call...
...without incentives to use it, information alone will not lead to reform. Obama wants to make evidence-based medicine financially attractive so that providers are rewarded rather than punished for reducing readmissions and unnecessary procedures. "We can't just do research and let it sit on a shelf," Orszag says. It is fair for industry groups to insist on an independent agency to oversee the effectiveness research, so that decisions about what to study are separate from decisions about what to reimburse. And some of Obama's quality incentives are fairly straightforward, like extra dollars for primary care, prevention...