There is a fantastic article in the July 2014 issue of The American Journal of Medicine by Dr. Friedlander et al from the Vanderbilt University School of Medicine. The article is entitled, “Variation in the Intensity of Hematuria Evaluation: A Target for Primary Care Quality Improvement.”
Very short background: The very first sign of bladder or kidney cancer is microscopic amounts of blood found in the urine—usually without any other symptoms. No pain. No difficulty urinating. Nothing. The amount of blood is so small that you cannot see. Fortunately, there is usually another cause for the very small amount of blood—e.g. a urinary tract infection, inflamed prostate, etc. However, if blood is found in the urine, the standard of care is to have two follow up tests: a cystoscopy and a CT scan of the bladder and kidneys. The cystoscopy is a brief procedure performed by a urologist and the CT scan is typically ordered by the urologist as well. So if microscopic amounts of blood are found in a urine sample at a primary care physician’s office, the patient should possibly be referred to a urologist for further evaluation.
Now to the article: This study found that of patients who (1) went to see their PCP, (2) had a urine sample taken and (3) were found to have microscopic amounts of blood found in that urine sample—only 5.7% of the patients had the two recommended follow up tests performed to make sure there was no cancer present.
Approximately 94% of patients were not receiving recommended care.
What’s important about this study is that it is likely indicative of other guidelines that are not followed as well—and healthcare consumers are completely unaware that they are not receiving proper medical care.
These types of “errors of omission” also take place in a healthcare system where there are many “errors of commission” as well—e.g. too many MRIs being ordered for low back pain that will resolve on its own with pain medication and physical therapy. The US healthcare system is stymied by too little of the right care and too much of the wrong care.
So what does this mean for employee benefits professionals and healthcare consumers?
- One potential solution is to use a checklist—and to use doctors that use a checklist. Healthcare consumers would benefit from a checklist of the general guidelines of what medical care they should have for their age and gender (e.g. cancer, cardiovascular disease, diabetes screening). Employers and healthcare consumers should use physicians who themselves use a checklist, which is often incorporated into an electronic medical record and reviewed by the physician him or herself and the practice as a whole. I know of one health system that used a checklist for something as simple as booster shots for adult immunizations (e.g. tetanus shot) and improved the immunization rates of their patients as a result. As simple as they are—checklists work.