Tag: Waste

Misdiagnosis

Misdiagnosis

Posted on by jabittan
Healthcare spending has been increasing, but it is easy to see that we have a finite set of healthcare resources available to everyone. We only have so many hospitals, there are only so many doctors available, and our healthcare plans are all tied together so if one person uses a high amount of healthcare, everyone paying into the health plan will see their costs rise. This is one of the reasons why it is so important to make sure we are getting the best care possible with our healthcare dollars, why it is so important that we ensure that everyone gets the right treatment at the right time.

 

As Dave Chase writes in The Opioid Crisis Wake-Up Call, “A senior executive at a Fortune 10 company wisely told me that misdiagnosis is the biggest healthcare error; everything that follows both harms the patient and costs you.” 

 

If we don’t get the diagnosis piece right for patients, then they get the wrong care. They take medications that don’t help them, undergo procedures that don’t address the correct issue, and eventually return for more evaluation and diagnostic testing. The patient can be harmed by drug side-effects, by surgeries that were never needed, and by exposure to radiation from diagnostic imaging.

 

Getting the diagnosis wrong also wastes a huge amount of our finite healthcare resources. Each new appointment to try to get the diagnosis right, to do more testing and screening, or to try a new procedure leads to increased costs for the individual and everyone else. Doctor’s offices have to fit in more appointments, patients have to fill more prescriptions to try new medications, and operating rooms are booked for the wrong procedures. Individuals and patients are delayed and have to pay more for their services.

 

It is important that we focus on making sure we get the correct diagnosis at the beginning. I’m not a physician, and I haven’t spent years connected to the healthcare system to tell you exactly where the breakdown is in finding the right diagnosis, but the costs of patient health and healthcare resources make it clear that we should invest in diagnostic capabilities. We don’t need to spot every little thing in the patient’s body, but we do need good enough diagnostics and enough knowledge and understanding to get the right diagnosis the first time, for the good of our bank accounts, and more importantly for the good of our collective health.
Guidance Toward High Value Care

Guidance Toward High Value Care

Posted on by jabittan
In his book The Elephant in the Brain, Robin Hanson explains that a lot of medical care and healthcare services are more about signaling than about the value they bring to the patient in terms of improved health and effective management or treatment of a given condition. Healthcare has a lot of signaling, showing others that we make enough money that we can go do something for our health, pushing others to get care to show how much we value having them be healthy, and giving us or others a chance to show how much we know and understand the human body. However, not a lot of what we push people toward really demonstrates that it adds a lot of value.

 

This is a problem that Dave Chase thinks is a big contributor to our nation’s healthcare woes in his book The Opioid Crisis Wake-Up Call. Chase is critical of unnecessary services and a medical system that pushes people toward care, without providing means to ensure that the care we push people toward is actually valuable. He recounts a conversation he had with Dr. Martin Sepulveda, “indiscriminate provision of health care services – absent efforts to help people understand how to use those services – leads to voracious appetites from both patients and providers for services that add little value but add a lot of cost to the individual, company, and society.”

 

When a child runs to their mother for a kiss on a bruised knee, the kiss doesn’t actually add any value in terms of helping heal the child’s bruise. But the care provided by the mother does signal her love for her child, signals to the child that they are valuable and important, and signals to others that the child has allies who will aid them during a time of need. The example is extreme, but if you look close enough, you will see some of the same aspects at play in many of our healthcare interactions.

 

Increasing access to healthcare without helping people understand what care they should seek, without helping people understand what options they really have, and without guidance toward high value care, means that we will use healthcare in a wasteful manner. Paying providers just by the number of procedures they do, and not by how much they help patients, encourages unnecessary medical procedures. Telling patients that if they value themselves they will go to the doctor every time they feel a little off will lead to patients overusing primary care. And pushing people to the emergency room every time they say they don’t feel well could crowd our ERs and delay care for those who really need it. The problem is difficult to solve, and I want to acknowledge that it is hard to know what care is really appropriate and what is wasteful signaling. That is the point that Chase makes. Without more transparency and clarity in the system, we won’t really know what medical services we should and should not pursue, and we (along with providers) will likely overindulge in high-signaling low-value care rather than medical treatments that are really useful and meaningful.
The Specter of Rationing Care

The Specter of Rationing Care

Posted on by jabittan
American’s fear having to wait for anything. We want to order things from the comfort of our own home and have them delivered in two days. We don’t want to wait behind more than three people in line at the grocery store, and we don’t want to wait for medical care (to be honest these are all examples from my own life – not picking on anyone who isn’t like me here). Our fear of waiting is used as a reason against universal health coverage. We are told about Canadians who cross to the United States to have surgeries that they would have to wait several months to have in Canada. We are told that we won’t be able to schedule an immediate primary care appointment if more people were to have access to health care. And we are told that the high costs of medical care stop unnecessary care from happening, preventing us from having to wait to see a doctor.

 

However, these fears of waiting and the specter of rationing care presented to us in these scenarios is overblown. It is true that some Canadians chose to get care in the United States for elective procedures, but presenting that fact to us in isolation is misleading and done in bad faith. The reality of our waiting for care is much more complex. Dave Chase does a good job of explaining it in his book The Opioid Crisis Wake-Up Call, “People often raise the specter of rationing care. In reality, it’s overuse (i.e., unnecessary and potentially harmful care) that leads to reduced access by squandering enormous financial resources that would be better used for individuals who actually need care and can’t get it.”

 

We act as though our healthcare system is following good market incentives to find a good balance between wait times and receiving the right care. But we often fail to acknowledge that our healthcare system isn’t performing like an ideal market, and that it often pushes people to too much of the wrong type of care. Chase details this in his book with unnecessary back surgeries. Those who have a legitimate need for a back surgery might have to wait, because primary care providers get a bonus when they refer patients to orthopedic surgeons who are paid to operate. The right path for a patient might be physical therapy, but the money for the providers is in the surgery.

 

We should not raise the specter of rationing care when we are so wasteful with the care we provide through our current system. We waste a lot of money when we don’t have a concern about rationing care, and when we reward providers for doing more surgeries, prescribing more pills, and offering more treatment, even if the efficacy isn’t proven. In his book, Chase doesn’t advocate for a universal coverage system with healthcare covered by the federal government, but he does show how employers today can do more to ensure their patients get more of the good care (the effective PT and preventative check-ups) for free. This reduces the demand on the expensive and unproven treatments later on, and actually reduces the demand on the system for services that we are afraid of rationing.

Wasteful Signals

Posted on by jabittan
One of the great things about competitive markets (in an economic sense) is that they reduce waste. If multiple firms are competing against each other to sell a good, each firm has an incentive to find a new way to produce their good that makes the process cheaper and quicker. This allows each firm to eliminate waste, and over time the efficiency of the market improves, costs come down, and we are able to produce a given thing using less energy and resources.

 

But when we look at living creatures and consider evolution, we don’t always see the same thing happening. “The problem with competitive struggles, however,” write Kevin Simler and Robin Hanson in their book The Elephant in the Brain, “is that they’re enormously wasteful.”

 

The simple view of evolution that I always held was that animal species evolve over time to become better. Survival of the fittest meant that smaller, slower, weaker animals in a population would die out, and we would be left with the best individuals and the best genes reproducing into the future. The resulting population would be smarter, faster, sleeker, and in some ways more efficient. But evolution, it turns out, is more complicated than this simple model, and survival of the fittest is not always the best way to describe how evolution works. There is still a lot of random chance, random accidents, and waste that can occur in evolution.

 

In an earlier post I shared Hanson and Simler’s story about redwood trees competing against themselves to become taller. The trees did not compete to live in as diverse an ecosystem as possible, and if they had, Simler and Hanson suggest the trees could have been much shorter and could have occupied more space. The trees are wasteful, driving toward new heights in a confined area rather than efficiently spreading out and remaining at a smaller size.

 

In many ways we do the same thing. Creating a beautiful painting is wonderful, but it is also a bit wasteful. One reason we may want to create art is to demonstrate that we can do something relatively difficult to impress other people. We deliberately create something that uses resources for no practical value as a way to demonstrate that we have extra resources to burn and extra time to spend practicing and creating art. It is an indirect way to say, look how impressive I am and look how many resources I have that I don’t have to spend my time accumulating more resources and can instead use them in any way I choose.

 

We create art and buy fancy sports cars to be wasteful with resources to show off and signal something about our suitability and desirability as a mate. There are other things happening here of course, but this is a key component. Animals develop expensive plumage to signal to mates. Some birds will build fancy nests with shiny objects in them to catch the eye of a potential mate, and others will battle among each other to show which animal is the most physically dominant. Shows of skill, strength, and suitability as a mate can be very expensive using energy, time, and resources that could otherwise go toward finding more food. Evolution has lead animals to be very wasteful in a way that we would not expect if evolution worked like an ideally functioning market. Evolution is not simply survival of the fittest, sometimes there are other elements that get us to waste a lot of resources in our signaling competitions to pass our genes along. Sometimes evolution is selecting for things that really don’t seem to demonstrate a lot of great fit in a direct sense for a species.

Keep What’s Meaningful

Posted on by jabittan
The last few weeks I have been wasting time with thing that are not meaningful. My time and attention have been eaten away by things that don’t add value to my life and leave me feeling slightly guilty.

 

This morning I recognized, when I took advantage of an extra 30 minutes in my schedule, of how important it is to keep valuable things in our lives by cutting out the wasteful things. The easy path through life is filled with distracting, quick, and ultimately meaningless parts and pieces. We stay up too late watching pointless tv. We oversleep and eat low nutrition and thoughtless breakfast foods. We purchase large houses and put up with long and wasteful commutes. We make decisions all along the way that we don’t realize sacrifice our time, attention, and ability to meaningfully contribute to the world.

 

These observations on how society pushes our lives lead me to reflect on our daily decisions. I believe we all need to think critically about what are the most important factors in our lives. From there, we can begin to consider the large overarching decisions that we make to shape our lives. Once those decisions have aligned with our core values, we can start to think about the million small decisions that we make each day. This will bring our lives into alignment with our core values and help us cut out things that do not bring us value. It will help us think about what is meaningful and what decisions will help us  build a meaningful, thoughtful, and fulfilling life. Without this approach we won’t be able to think about how we live and our life choices, and we will fill ourselves with meaningless distractions and wastes of time.

 

Looking back at quotes I have written about, a quote from Colin Wright in his book Becoming Who We Need To Be seems particularly fitting with these thoughts. He writes, “Pursuing what’s meaningful is important, but just as important is understanding why we’re pursuing what we’re pursuing and how we’re undertaking that pursuit. Pay attention to the why behind your actions, and the how and what become a lot easier to define and control.” Understanding that why helps us see what we need to do to get to a place where we can have a valuable impact on the world. Each of the daily actions that we can take become more clear when we understand our motivations and what we truly want to work toward. Thinking deeply about purpose and meaning gives us a sense of how to make the most out of the short time we have on this planet.

Carelessness

Posted on by jabittan
“The most disgraceful kind of loss, however, is that due to carelessness,” Seneca wrote in a letter to his friend Lucilius almost 2,000 years ago. Seneca’s Letters from a Stoic is a collection of short passages written from Seneca to Lucilius full of interesting reflections on life. His quick quote about carelessness seems to be as fitting as can be for our times today.

 

We live in a time where great possibilities are open to most of us. On a given weekend we can volunteer our time for a meaningful cause, go snowboarding, go to the beach, visit family, or work on an art project, or try to finally get the garage cleaned. Often, however, we might find ourselves in a position where our time slips past us, and our weekends are lost to Netflix and squandered on meaningless activities. I often look forward to the promises of the weekend on Friday with excitement, but end up looking around my place on Sunday night reflecting on everything I planned to do but never managed to get to. We don’t need to pack every minute of our free time with interesting, fun, and engaging activities, but what I feel on some Sunday nights, is the pain of a loss due to carelessness.

 

Much more seriously, our world faces very extreme consequences from global warming as we continue to put more carbon dioxide into the atmosphere. We face dangerous consequences from the  bioaccumulation of plastics in fish and wildlife species that eat our garbage. Millions of people in the deserts of the United States rely on water sources that are becoming depleted, yet water waste from leaks and unwise water usage persist. Our world faces various ecological crises that result more or less from our own carelessness. Just as I feel terrible some Sunday nights about the way I wasted my time during the weekend, we will look back at where we are today and feel extreme regret for the carelessness with which we wasted resources and allowed our planet to degrade.

 

Solving my problem on Sunday nights is not impossible. It just requires that I be more considerate about my time. It requires that I think about what I am doing and why I am doing it to ask myself if there are other things I should be doing and if I am going to look back and be glad that I spent my time engaging with any given activity. With some planning going into the weekend, I can be successful in engaging with the world in a meaningful way on my days away from the office. The same is true for our climate crisis. If we ask ourselves what we are doing and how our actions contribute to the overall sustainability of our planet, we can start to make small changes to live better on our planet. We won’t individually make much of a difference, but collectively we will start to make changes and we can all contribute to a consciousness about the importance of using our resources wisely. That mindset will eventually translate into smart decisions globally to help us mitigate our impact on the way things are going and prevent us from a disgraceful loss of a habitable planet due to our own carelessness.