Is More Always Better? Not Necessarily When It Comes to Healthcare

Oct 19, 2015, 8:00 AM, Posted by

Healthcare professionals, patients, and allies across the nation are banding together to promote an understanding of what good medical care can and should be with RightCare Action Week.

Sometimes, more is definitely better. Getting that extra hour of sleep can greatly benefit your mind, body and day. Cars that get more miles per gallon are cheaper and cleaner to run. And who would argue against more vacation time?

But when it comes to health care, more is not always better. Unnecessary diagnostic tests, treatments or hospitalizations can drive up health care costs, and in some cases, actually harm patients. For example, excess imaging increases exposure to radiation. Overuse of screening and diagnostic tests can lead to stressful false positives. And unnecessary treatments, drugs or procedures increase the risk of serious complications. In the larger picture, the estimated $200 billion spent on inappropriate care each year diverts resources away from services that are actually needed both within and outside of the health system—in mental health, housing, and infrastructure, for example—that can help all Americans lead healthier lives.  

To build a Culture of Health we need to make sure all Americans get the health care that is right for them, at the right time. In order for that to happen, everyone needs to understand just how widespread the problem of inappropriate care is. That’s why the Robert Wood Johnson Foundation (RWJF) is partnering with the Lown Institute, an organization that is working to advance a culture change in health care delivery. Their goal is to influence providers to reject the “more is better” paradigm in health care, and focus instead on providing compassionate and appropriate care for every patient. 

To raise awareness about this issue, the Lown Institute is sponsoring RightCare Action Week. During the week, healthcare professionals, patients, and allies across the nation are encouraged to engage in a series of activities to promote understanding of what good medical care can and should be.

These specific RightCare Actions fall into three general areas:

Overuse Count—Physicians, practices and other providers recognize and record each instance of medical overuse they encounter over the course of the week and then share them with the RightCare Alliance and colleagues.

Story Slam—Patients, doctors, medical students and others are invited to gather together and share their own personal stories about witnessing or experiencing overuse or inappropriate care.

“What RightCare Means to Me” Photo Campaign—Participants post photos of themselves on Twitter and other social media holding signs that tell the world what RightCare means to them.

Right here at RWJF we are very excited to participate in the inaugural RightCare Action week. Our staff is joining together to share their own stories of overuse and inappropriate care. Many have already provided daunting accounts such as  unnecessary testing during a normal, uncomplicated pregnancy; inappropriate diagnosis, medication and treatment that stem from incomplete patient histories and conversations; unnecessary preoperative tests, and doctors prescribing unneeded antibiotics and other medications.

On the flip side, we also heard stories of underuse; where patient histories were not accounted for, and in one case, led to a delayed cancer diagnosis that caused significant harm to a patient. Listening to these stories heightened everyone’s awareness and understanding of how common and harmful the problem of inappropriate care is, and how it manifests itself differently across demographic groups.  

Engaging in an open dialogue and sharing stories is part of a larger commitment that we have made here at the Foundation. We want to ensure all Americans have access to appropriate, patient-centered care. The Lown Institute’s RightCare Alliance aims to drive a cultural change in health care, to move away from “doing more to the patient” and towards figuring out what constitutes appropriate, compassionate care for each individual patient.

We are also supporting many other initiatives that get to the heart of overutilization. For example, Choosing Wisely employs evidence-based recommendations to stimulate discussions between providers and patients about the need—or lack thereof—for many frequently ordered tests or treatments. The Foundation also funds several projects aimed at providing better care for high-cost, high-need patients who cycle frequently through the health care system, often undergoing duplicate tests and being prescribed medication they can’t afford. In the case of these complex patients, “right care” may mean providing help with food, safe housing, and connection with social services that are outside the traditional health system.

A high-value health care system, where the nation gets the most out of the investments that we make in health care and population health, is a centerpiece of RWJF’s Culture of Health strategy. Through RightCare Action Week we hope to raise awareness of these issues and offer a starting point for conversations about making sure that well-informed patients receive effective, affordable and needed care.

Emmy Ganos, PhD, is a program associate at the Robert Wood Johnson Foundation focused on ensuring our economy is less burdened by excessive and unwarranted health care spending. Read her full bio.

Tara Oakman, PhD, is a senior program officer at the Robert Wood Johnson Foundation focusing on strengthening vulnerable children and families and working to improve the value of national investments in health and health care. Read her full bio