My first visit to the emergency room of a hospital occurred last summer, while I was on a school volunteer trip to a remote town in Illinois. I spent the night in an old log cabin, on a small bed that had been infested with hundreds of fleas and ants, which, overnight, bit my legs and buried under my skin. I woke up with sharp pain in my legs and saw blood all over my bed linen. I was rushed to the nearest hospital in an ambulance, where I was told that I needed surgical treatment to prevent the fleas from further damaging my blood vessels. I was then relocated to a larger hospital, where I was told that I only needed to get a few steroid shots. The doctor also quickly drew up an Option Grid and explained to me and my supervisor the pros and cons of each treatment option. Pointing at the “surgery” grid, the doctor explained that there are very little side effects to surgery other than a scar but that it’s expensive and requires more time to heal. Then, pointing at the “injection” grid, the doctor explained that a steroid injection is less costly and more convenient but that there may be multiple side effects, such as weight- gain and other medical conditions. Upon consultation, my parents, my supervisor, and I decided to treat my legs with a steroid injection. After receiving the steroid shots, my legs healed in just a couple of days and I was able to walk again. I did, however, gain a lot of weight, as the doctor had predicted.

What I thought strange from my first foray into emergency medicine was how one doctor from one hospital told me one thing – surgery – and another doctor at a different hospital recommended something different – steroid injection.

Feeling troubled in witnessing such variation in medical care, I spoke with Dr. Kim Donghyun, a rheumatologist who previously worked at a private hospital in California. Dr. Kim explained that despite the substantial developments in the healthcare system of the United States, variations in the care of medical conditions still remain a serious problem. “For many conditions, surgery is only one of several care options, some of which may involve several different types of surgical procedures. Whether a patient receives one surgery over another or is treated with some other alternative care instead of surgery largely depends on the location and the surgeon treating the patient.”

Such geographic variations are of grave concern, because too often, surgical, as well as medical, care is recommended by healthcare providers without taking into account the full needs and preferences of their patients. Optimal care for patients is being underprovided and, in many cases, is not being sought after for alternate reasons and intentions that benefit the surgeon or the hospital at the expense of the patient’s well-being. This poses serious financial and health problems for a large percentage of the U.S. population and the government funding the treatments primarily through Medicare. Geographic variations in the care of medical conditions and induced care is, therefore, associated with an unhealthier population, higher costs, lower patient satisfaction, higher hospital readmission rate, and higher risk.

Citing spinal stenosis as an example, Dr. Kim further explained that there are three major ways to treat the disease – managing without injections or surgery, injections, and surgery – each of which are further divided into different types of medication, injection, and surgery, respectively. There are variations between and even within each treatment option. For example, some doctors prefer to treat spinal stenosis by managing without injections or surgery, although not all patients require or prefer medical management. Also, there are several different types of medication that physicians can prescribe to their patients, and there is very little consensus as to which medication is most effective in treating the disease. “Since the late 1990s, there has been a surge in the use of opioids to treat spinal stenosis. Clinical guidelines discourage physicians from prescribing opioid to their patients due to the questionable effectiveness of the drug and the complications that follow, but the use of opioids continues to rise without a well-known cause. This reflects how new research and information on the effectiveness and risk of opioids are not efficiently distributed to, as well as between, patients and providers. Both patients and physicians may overlook the risks of opioid usage and may only be concerned about the short-term effects of pain relief, which has no effect on the natural progression of the disease,” Dr. Kim stated.

There have been efforts by state, nonprofit, and private actors to address the lack of information sharing between patients and healthcare providers. One such actor is EBSCO Health, which specializes in providing evidence-based resources to patients and the global healthcare community through its Option Grid Decision Aids. EBSCO Option Grids are brief, easy-to-read tools that help patients and providers compare healthcare options, thus encouraging patients and providers to engage in collaborative decision making. With the Option Grids, both patients and providers are able to weigh the health, as well as financial, benefits of each treatment option and arrive at a common decision. State governments who pay for Medicare and Medicaid also benefit financially from these programs. “Shared decision making is becoming more and more common around the world, and the United States – whose healthcare system is more fractured and complex than any other country – can certainly benefit from these innovative programs,” Dr. Kim concluded.

 

Minseo Kim 
Grade 12
Keith County Day School