Feature Right Care

Experts and activists discuss how to get “right care” for patients

BMJ 2016; 353 doi: https://doi.org/10.1136/bmj.i2406 (Published 29 April 2016) Cite this as: BMJ 2016;353:i2406
  1. Jeanne Lenzer, associate editor, The BMJ
  1. Jeanne.lenzer{at}gmail.com

Jeanne Lenzer reports on a growing movement aiming to overcome the medical and social barriers to appropriate care

The fourth Lown Institute conference held in Chicago, Illinois, in April brought nearly 300 doctors, patients, policy makers, and activists together to discuss barriers to “right care.” The focus was on how to tackle the problems of bad science, undertreatment, and overtreatment—and how to build a movement for change, which several speakers likened to the civil rights movement.

A recurrent theme among speakers and participants was that fee-for-service medicine and profit driven testing and interventions are major obstacles to right care. Speakers emphasized that this could be achieved only if we simultaneously address issues such as the wealth gap, social disparities, and corporate control of politics.

Shannon Brownlee, senior vice president of the Lown Institute, told The BMJ that the presence of a wide range of activists and organizations at the conference gives her hope that a genuine new social justice movement is emerging.

More money for less: the harms of finding things

Rita Redberg, editor of JAMA Internal Medicine, said, “We spend $3tr, far more than other countries, yet we still have millions and millions of people without access to healthcare.” She added, “The Institute of Medicine estimated that $1tr a year is spent on waste or overuse.” Both physicians and patients imagine that if some care is good, more must be better, and that a test can’t hurt.

Insurance coverage of unnecessary tests, said Redberg, contributes to overtesting and overtreatment: “The United States Preventive Services Task Force gave a grade D recommendation to PSA [prostate specific antigen] testing but Medicare still covers it, so it means a lot of men are still getting a test that is costing not just money, but lives.”

From the audience, Jill Wruble related her own experience with the unintended consequences of medical testing. …

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