I’ve repeatedly made the case that the health care debacle is an ocean with many tributaries, and that we physicians are one of them. I’ve also stated repeatedly that while medical-legal fears are fueling a significant portion of the doctor-related issues, it would be intellectually dishonest to say it’s responsible for all of the excesses. A recent article in Modern Medicine seems to provide an example of this, in my own specialty.

It appears that a disproportionate number of patients are sent for sophisticated stress testing within two years after revascularization, referring to opening of diseased coronary arteries either by balloon angioplasty/stenting or surgery. While a notable percentage of patients may get symptoms following the nonsurgical procedure, the numbers they cite far exceed the expected rates. And with surgery, a recurrence of problems within two years is very unusual with modern medical treatment. On top of that, the timing of the testing suggested more of a routine than symptom-directed approach.

In these difficult times the great minds in our industry, and in the country in general, need to come together and soberly analyze the systems from the ground up, because one word sums up our current approach to managing health care, our governments, and the economy in general: unsustainable.



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