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Doctors' Share of Waste in Medicine


The burden of too-high utilization of health care services and increasing costs is being placed on doctors, who want to please patients and can't kick bad habits. So what are they going to do to fix that?

— According to an article in JAMA, "Diagnostic and therapeutic overuse, waste and duplication are major medical cost drivers, accounting for up to 30% of all medical expenditures. Up to $1 trillion (30% of the annual $3 trillion health care bill) can be achieved without compromising care." Ouch! That's not "the other" docs they're talking about, that's you and me.

Another article, this one in Consumer Reports, puts the onus of too-high utilization, and therefore cost, on docs who 1) want to please patients, 2) self-prescribe malpractice avoidance, 3) say "It's hard to kick bad habits," and, importantly, 4) haven't risen above short-term financial self-interest.

What are we going to do about these difficult observations?

— An interesting study from Michigan State found that only about half of docs surveyed cleaned their stethoscopes even weekly. Almost 10% admitted that they never had cleaned them. To add emphasis, about 90% cultured out some kind of staph, for instance. Happily, just a brush with an alcohol swab killed over 90% of the bacteria. Thank goodness they didn't sample the build-up on our phones.

— The auto industry estimates that with just four sensor systems mounted on our vehicles, one-third of all fatal crashes and one-fifth of injury crashes could be prevented. These four are forward collision warning, lane departure warning, blind spot detection and adaptive headlights that turn when you do.

Beyond these, the advent of the Google-type self-driving car could conceivably completely eliminate the daily carnage on our streets and highways that we now seem to take for granted. The estimates are that such a system will cost about $5,000 per car and could be available in only a few years, once all of the jurisdictions have had a chance to modify their laws, as California has.

— For you gold bugs, and you know who you are, the U.S. Geological Survey reports that there are 171,000 metric tons of gold in circulation (roughly a 67 square foot cube) in the world and there are another 51,000 metric tons in the ground. Sea water contains an unknown, but assumed to be large, additional amount that is unavailable to current technology.

— If you are wondering if all that student debt was worth it, or is worth it for your high school senior about to impoverish you over the next four years, here are some recent stats on lifetime earnings for people with:

• no high school degree: less than $1 million

• a high school diploma: $1.4 million

• a bachelor's degree: $2.4 million

• any professional degree: $3.7 million

Four years of fun (unless you are pre-med) plus an educated mind = priceless.

— Interestingly, the wealthy are marrying at a much higher rate than the rest of the population, according to Worth magazine. Over 80% of men between the ages of 30 to 50 in the top 10% of earners are married, while at the bottom of the wage scale, only half of the men are married (compared to over 80% in 1970!). This is not a particular denial of the adage that "two can live as cheaply as one," but rather appears to be an under-the-radar, and profound, cultural shift — at least among the not-wealthy.

— Looking at the media, you would think that any bright 20-year-old who dropped out of school could get funding for some tech idea and become super rich shortly thereafter. The truth is different.

Research done in Silicon Valley shows the average entrepreneur is a professional about 40 who starts with his or her own funds. Twice as many are over 50 than under 25 years old and twice as many are over 60 than under 20. So there.

As a side note, venture capitalists have funded just 3,800 companies or .1% of the total.

— Lest you wonder about the underlying value of the entitlements that are driving the nation so deeply in debt, in 1966 the poverty rate for seniors was about 30%. Now it is under 10%. Very heart-warming, but we must find a way to run Medicare, particularly, much more rationally.

Oh, and docs should, and must, be much more involved in the process.

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