A reporting team’s in-depth investigation into a growing dental chain offers a troubling chronicle of dentists under pressure to meet revenue targets and patient allegations of overtreatment.
Reporters from USA Today and Newsy, the investigative unit owned by E. W. Scripps Company, spent more than a year examining the inner workings of North American Dental Group. The Pittsburg-based chain represents “a new trend of dental offices bought by private-equity investors and turned into revenue-generating machines,” their project explained. Continue reading
Balancing the challenges of underdiagnosis (missing or delaying important diagnoses) and overdiagnosis (labeling patients with diseases that may never cause suffering or death) can feel like walking across a canyon on a tightrope. Diagnostic errors occur in an estimated 10 percent to 20 percent of cases and will affect most Americans at least once in their lifetime. They are the leading cause of medical malpractice claims, harming more than 4 million people at a cost of more than $100 billion. Continue reading
With the recent announcement of the American Cancer Society’s change in mammography and breast cancer screening guidelines, the question of when women should get screened is back in the spotlight. The issue is far from simple, as I learned when reporting on it last month for Cure Magazine, before the society’s change was announced.
As one researcher told me then, the goal of screening is to find a tumor that otherwise would not have been found – and find it early enough to undertake treatment that will save the patient’s life. Yet many other outcomes can also result from screening, ranging from false positives that can cause an intense (but hopefully brief) period of anxiety to identifying a non-invasive cancer that is treated with mastectomy, radiation or chemotherapy even if it never would have caused the woman harm. Continue reading
Siobhan O’Connor recently explored in a Time magazine piece an issue that has been gaining traction in both the medical world and the media reporting on it: the overtreatment of breast cancer.
Her story, “Why Doctors Are Rethinking Breast-Cancer Treatment,” opens with an anecdote from now-60-year-old Desiree Basila, who several years ago decided to do … nothing after receiving a diagnosis of ductal carcinoma in situ (DCIS), a stage 0 cancer in the breast ducts that was not invasive – and may never become so. What makes this opening anecdote striking was not simply Basila’s decision – one that has been discussed more often in recent years – but when it occurred: Continue reading
In June 2009, Atul Gawande wrote an influential New Yorker article, about the community of McAllen, Texas, which has some of the highest per-capita Medicare costs in the nation. At the time, “The Cost Conundrum” had a significant impact on the national debate over the legislation that would become the Affordable Care Act – not so much on the health insurance coverage aspects but about wasteful spending and flawed incentives built into our payment system.
McAllen was awash in waste, fraud and abuse, with millions spent on care of little to no value to the patient. The spending could not be blamed on socio-economic factors because nearby El Paso was a very similar community, but with half the per capita Medicare costs, and same or better outcomes. Gawande wrote this about McAllen: Continue reading