Sometimes, the best medicine is the simplest

Since I have been writing for this blog, my friends and neighbors have been peppering me with stories about how they were misdiagnosed, how badly they were treated by a physician or health care system, or how modern medicine should be changed. The trail of mishaps in our health system is endless. Here is one recent episode told to me by a neighbor that seems to epitomize much of the trouble underlying health care.

My neighbor is an elderly woman in her late 80s. She lives alone and has trouble accessing medical care. One day, she woke up with an acute episode of vertigo and felt that the room was spinning around her. She called for an ambulance and was immediately taken to the nearest emergency room. After a two-hour wait, she was seen briefly and received a CAT scan, an EKG and blood work. All of these came back as normal. Finally, the attending physician sat down with the patient and did a more thorough history and physical examination. To his relief and embarrassment, he discovered that the patient had an ear infection that most likely caused the vertigo. He treated the ear infection, sent her home with medication, and she rapidly recovered.

What can we learn from this story? First of all, elderly patients have difficulty seeing their primary care doctors on a semi-urgent basis. This is especially true for those with limited means of transportation. Therefore, they have no choice but to call an ambulance and visit an emergency department, significantly increasing the cost of health care. We need more urgent care centers that provide care immediately but at a lower cost than emergency departments.

Second, we need to rein in medicine's overreliance on algorithms to determine treatment. First line doctors are currently trained to use them to determine automatically the treatments and tests to order for different kinds of presenting symptoms. What about a good old-fashioned history and physical examination? These are not well reimbursed, but they can save the patient from many expensive, potentially dangerous and certainly unnecessary tests.

We have streamlined and automated so much of our care that we have lost sight of the most basic needs of patients. Sometimes in health care, simpler is better.

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