Can Hospitals Avoid Waste and Prevent Overtreatment?

U.S. News talks to Nobel Prize winner Dr. Bernard Lown about simplifying medical management.

Dr. Bernard Lown, peace activist and founder of the Lown Cardiovascular Research Foundation in Brookline, Mass., has advocated for reducing waste and overtreatment in American medicine.
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U.S. News: You were doing about a third the number of CABG (coronary artery bypass graft surgery) procedures as your peers. Your beliefs ran counter to the medical establishment, but your research and publications proving that far too many people were undergoing bypass surgery began to change minds. How was it working in an environment where you were a respected contrariarian?

Dr. Lown: I saw that people were getting CABG for mild angina or chest pain. In 1978, my group published in the New England Journal of Medicine that a majority of patients who have angina do not need CABG or stenting or angioplasty. I was regarded as a good doctor, devoted, competent and well known. But after I wrote that article, I got a call from a Brooklyn doctor. He said, "Lown." He didn't say "Dr. Lown." Just "Lown." Then he said, "Lown, with this one article you have done massive harm to humankind." Of course, I was upset. Nobody in life is free of doubt. It's the nature of science. If you don't doubt, you are not a scientist. But I was right.

U.S. News: There seems to be a growing recognition that overtreatment is a problem that can harm patients and dramatically increase costs. Last year, nine specialty groups came up with recommendations on tests and procedures that can often be avoided. Are you encouraged by these changes?

Dr. Lown: I would say categorically that things are shifting in public attitude. From my Nobel Peace Prize, I learned one thing: That political change is made by people who are persuaded, convinced and ready to go to bat for an issue. They're worried but not intimidated by their anxiety. They are willing to act.

Right now the public is ready to see changes in health care. And the medical profession, interestingly enough, seems to be ready, too. Surveys show that 80 percent of Americans and 60 percent of physicians support a single payer health care system.

U.S. News: Problems with America's health care system are economic, but they are also human. What's been lost in modern medicine?

Dr. Lown: In my view the lost art of listening is a quintessential failure of our health care system. I think that you cannot heal the health care system without restoring the art of listening and of compassion. You cannot ignore the patient as a human being. A doctor must be a good listener. A doctor must be cultured in order to understand where the patient lives, why he lives like that, and also realize that the leading cause of disease in the world is poverty.

U.S. News: What can a doctor gain by listening to, and really knowing, a patient?

Dr. Lown: One of the weaknesses of medicine is that there are no home visits. Let me tell you an interesting story. I had a patient who weighed 250 pounds. His wife came in with him and I told them about the diet he should follow. When they returned, he was still 250 pounds. He said he's adhering to everything I said. His wife said that he's following instructions, and he's not losing weight.

So I asked our nutritionist to look into this patient. She made a home visit. She said that she looked all over the house, and she found a freezer in the basement. It was full of ice cream. The patient told her that he had a quart of ice cream every night to help him sleep. He didn't understand about the enormous amount of calories in a quart of ice cream. I told him that in addition to the recommended diet, he had to stop eating ice cream. After that he lost weight. We wouldn't have discovered this without a home visit.

U.S. News (to Dr. Saini): How can you get a majority of physicians on board to change their practices in order to avoid waste and overtreatment? After all, their income can depend on ordering more tests and procedures.

Dr. Saini: I know that there are a few bad apples. But most physicians are not consciously overtreating. It's more systemic. Everything is tilted in the direction of doing more, and the fact that physicians have made their living ordering these tests is fuel on the fire. But the timing is such that we think we can remind doctors, remind the tribe, of the calling of our profession. Financial security was always expected, but not the reason for getting into medicine. Also, conditions of work are increasingly feeling very unprofessional to doctors. Many want to change how they practice medicine.



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