The Cost of Hope

Steven R. Peskin, MD, MBA, FACP

Amanada Bennett, a Pulitzer Prize winning journalist, chronicles the poignant journey that she and her now deceased husband, Terrence Foley, traveled in his seven-year battle with a rare form of kidney cancer. The Cost of Hope puts into sharp focus the convoluted compexity of our health care system even for two well educated, well insured individuals with superior skills to acquire, parse and synthesize information and data.

A recent experience helping a friend with advanced cancer to navigate within two large, highly rated health care systems brought home in a very personal way the frustration and fear that our sometimes seemingly impenetrable “system” may evoke. Like the Bennetts, my friend was well informed, well insured, and had superior abilities to access and analyze infomation about his own illness.

The cost in the Cost of Hope is financial as well as emotional. Over the past few days I have asked fifteen people — nurses, physicians, and non-health-care professionals, “How many CT scans do you think that a person with a diagnosis of kidney cancer received over seven years?” (Before you read further, make your estimate.)

My informal polling of these 15 people was 18 to 30.  Amanda Bennett and her husband decided to pore over the reams of information that they had received from insurers and providers to satisfy their curiosity about the number of CT scans performed. To their astonishment, the number was 76. Though the book does not do an evidence-based retrospective analysis of the appropriateness of each of these scans, the author's perception, shared by the 15 people that I polled, is that a substantial number of these scans were unnecessary.

In the aim for the Triple Aim, we were 0 for 3.

Steven R. Peskin, MD, MBA, FACP is associate clinical professor of medicine at the University of Medicine and Dentistry of New Jersey — Robert Wood Johnson Medical School.

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