they don’t do this is unclear, and a number of potential explanations have been put forward. These include not being able to afford the medicine, a lack of time to fill the prescription, difficulties in opening the container, and a fear of possible side effects. A recent poll by Consumer Reports indicated that 45 percent of U.S. consumers who don’t have prescription drug benefits fail to fill their prescriptions because of cost. Some 62 percent of these people declined a medical test for the same reason, and they also skipped recommended medical procedures and put off doctor visits. Since almost half of adults take prescription medicines, this indicates that millions of people are not getting the medicines they need to stay healthy. The Centers for Disease Control reported that some 36 million Americans have uncontrolled high blood pressure, putting them at an increased risk for stroke and heart disease. As a result, nearly 1,000 people a day die, and the direct cost of this is estimated at $131 billion per year. Finally, a recent Kaiser Permanente study found that nearly 30 percent of women failed to pick up new prescriptions for osteoporosis. One approach taken to combat this problem (and which appears to be successful) is actually paying patients to take their medicines. Compliance by patients taking medicines for HIV and tuberculosis was increased for a surprisingly low amount of money.
Simple Checklists Improve Surgical Outcomes
Adding something as simple as a checklist into the surgical suite environment was widely met with resistance when it was first introduced. As doctor and author Eric Topol once described it, “Of all the professions represented on the planet, perhaps none is more resistant to change than physicians.” Despite the fact that the checklist concept is already firmly entrenched in other complex fields (e.g. flying airplanes), many doctors wanted no part of this process and didn’t understand the need for it. This resistance is difficult to understand in light of the many well-publicized stories about what happens when things go wrong in the O.R. Surgery performed on the wrong limb or patient actually made up some 0.5 percent of all medical mistakes according to a study done several years ago. This means surgery is done on the wrong body part about 40 times per week across the U.S. The eventual acceptance of checklists at a number of medical centers and hospitals showed that these lists really do help reduce patient morbidity and mortality. I felt very reassured during a recent medical procedure when I was asked by person after person for my name, my birthdate, and what treatment was I there for.
The examples go on and on. We know that many people can’t afford to see a doctor, and the number one cause of bankruptcy in the United States is unpaid medical bills. By using the phrase “can’t afford,” I’m not just referring to not having the money to pay a bill. Sometimes these patients can’t afford to get the time off from work (they’d get fired), or they can’t squeeze the time into their rigid work schedules to receive a lengthy and debilitating series of radiation treatments. The special problems that poor people encounter in trying to meet their health care needs are well described in How We Do Harm: A Doctor Breaks Ranks About Being Sick in America by Otis Brawley (with Paul Goldberg). The book is filled with heartbreaking anecdotes that illustrate how the availability of new medicines and treatments (as well as older ones) do not trickle down to many poor Americans. The first story in the book sets the tone, about a woman who arrives in the ER carrying one of her breasts in a plastic bag. It’s literally fallen off due to advanced cancer, and her primary request is to find a doctor who is capable of reattaching it. The story, sadly, did not have a happy ending.
The data seem pretty clear: we need to adopt a more comprehensive, cost-effective approach to providing health care solutions that benefit the most patients. In many cases this means turning to low-tech approaches. I’m not arguing that it’s time to radically scale back on trying to develop viable treatments for amyotrophic lateral sclerosis (ALS), pancreatic cancer, or any number of rare diseases. It’s simply time to acknowledge that as a society we may get the most bang for our healthcare bucks by investing more in trying to help our citizens use approaches that don’t cry out for a science/technology/engineering/math (STEM) education. Let’s focus on making sure that prescriptions get filled and people can afford to see their doctors in a timely way. For all of the money and resources we devote to developing new treatments and medicines, it seems pretty clear that compassion and common sense need to be a part of the equation as well.
