Less Is Sometimes More
A hopeful trend that’s gained some serious momentum this year—and may be connected to both the recession and some provisions of the Affordable Care Act—is that we’re beginning to question whether we really need quite so many tests and drugs. By ‘we’ I mean researchers, some journalists, some nurses and physicians, and of course patients. The answers aren’t always clear, and there’s plenty of room for disagreement on many such issues, but at least we’re asking the right questions more often, rather than retreating in fear and simply hurling around the word “rationing”:
Who really benefits from prostate and breast cancer screening and who is more likely to be harmed, and why? When are you too young or too old to be likely to benefit from a certain type of screening? When does aggressive care at the end of life cease to make sense? Are we confusing a risk factor with a disease, an association with causation, relative risk with absolute risk?
Does that drug you see relentlessly marketed in advertisements during breaks in the network news actually help you? Which physicians are being paid as consultants in support of various drugs, tests, or treatments, and does this compromise their objectivity? And so on. The latest example of this kind of analysis I’ve stumbled across can be found here: “Disease Creep: How We’re Fooled Into Using More Medicine Than We Need.”
The Many Faces of Nursing
So, that’s one good sign as the year heads toward its close. Another is that nurses are making their voices heard and finding new roles and new ways to use their knowledge and skills as our system begins to slowly transform itself. And they are also blogging and sharing ideas on Twitter, organizing in support of safe staffing and fair wages, getting elected to Congress and assuming major leadership positions in health care organizations, providing essential primary care as nurse practitioners, spearheading quality improvement initiatives, learning new technologies, volunteering in disaster zones, doing exciting new research, providing crucial and compassionate bedside care, advocating for patients, and much more.