In Alfred Hitchcock’s “The Man Who Knew Too Much,” Jimmy Stewart plays a typical middle-aged guy named Ben who signs up for one of those comprehensive and ridiculously expensive executive physicals. In the process, he finds out things about himself he didn’t know before — such as that he might be dying of a horrible disease. Or not. There’s just no way to be sure without further testing.
Long story short, he spends another small fortune, works himself into a cold, sweaty panic, and then finds out it was really nothing and he was fine all along. The movie closes with a touching scene in which his physician puts a hand on his shoulder and says, “See, Ben? I told you it’s a wonderful life.”
“Thanks, Dr. Potter,” he responds gratefully. The end. Fade to black, followed by a cavalcade of needless medical and psychotherapy bills. And of course, that’s not the actual plot of the movie. Sometimes I make things up for no good reason, just because I can.
“Too much information.” That’s a phrase I hear the kids using a lot these days as they menace the sidewalks on their long-boards. They actually say “TMI,” apparently because kids today are so very focused that they must abbreviate things in order to be even more efficient and productive. LOL. Anyway, when it comes to annual physicals, I’m pretty sure the phrase applies. There’s just too much TMI for our own darn good.
The New York Times agrees with me, or maybe it’s the other way around. “Scientific research has shown that annual physical exams—and many of the screening tests that routinely accompany them—are in many ways pointless or (worse) dangerous, because they can lead to unneeded procedures,” begins an article subtly titled “Let’s (Not) Get Physicals.”
So as patients, why do we still run like lemmings into the clinic every year? As providers, even in long-term care, why do we still recommend tests and procedures that may not be necessary or even useful? The author finds plenty of blame to go around. Things like the fee-for-service payment model. Drugs and procedures marketed directly to consumers. The preponderance of specialists. And even our own misguided habits, since doctors tend to offer the services consumers have come to expect and demand. We’re the market, after all.
But the times they are a-changin’. Recently, amazingly if you ask me, a coalition of doctor groups and consumer organizations got together and identified 45 common tests and procedures whose usefulness should be questioned if they’re offered. As outcomes and quality get tied to payment and the sharing of data increases through electronic health records, recommended guidelines can increasingly be followed and offered in good faith, and we can all resist the urge to go to the doctor until something hurts or falls off.
In other words, in this new golden age we’ll consume as consumers, and provide as long-term care providers, “The Right Amount Of Information At The Right Time.”
That’s better than TMI, though I realize TRAOIATRT isn’t nearly as catchy.
Things I Think is written by Gary Tetz, who cobbles these pieces together from his secret lair somewhere near the scenic, wine-soaked hamlet of Walla Walla, WA. Since his debut with SNALF.com at the end of a previous century, he has continued to amuse, inform and sometimes befuddle long-term care readers worldwide.
