I’ve been under the impression that health care in the United States has dramatically improved over the last few years.

Then I read an article in the October edition of The Journal of the American Medical Association about the trends in health care delivery to adults in the United States from 2002 to 2013.

During this time, Google became popular, and then became a verb, Facebook was founded, Twitter made people use ever shorter sentences, and the medical system, well, it got nicer. That’s about it.

Doctor
Doctors may be improving their bedside manners, but they’re still falling down on when to use certain procedures and when not to. Ale Proimos/Flickr.com

Harvard University researchers determined that despite the advances in technology and the increasing utilization of electronic medical records, the only areas where health care delivery made substantial gains was in the patients’ experience of their medical care.

Patients reported doctors were nicer, communicated better and were more available.

Some of the findings illustrate where medicine has fallen behind. Rates of inappropriate antibiotic use increased from 50 percent of the time to 66 percent of the time. That means that two-thirds of the prescriptions for antibiotics were unnecessary by current medical guidelines.

Cancer screening is most appropriate in the age groups where the early diagnosis and treatment are effective and can save lives. For cervical cancer, the rate of unnecessary screening in the elderly used to be 62 percent, now it’s down to 49 percent.

Although that is statistically better, it still begs the question, why are almost half of the elderly women studied receiving a pap smear test that they don’t need?

Better health care is endlessly more important than whether or not the doctor is nice or talks well.

Apparently everyone has gotten quite excited about colon screening, and even though the guidelines suggest that testing over the age of 75 might add unnecessary risk, plenty of seniors are diligently doing their colon testing. Thirty percent did the test inappropriately in 2002, 39 percent in 2013.

As time has gone on, more people who don’t need to test their colon do and medical doctors are the ones recommending it.

There were some improvements, although when looking at the absolute numbers it seems like there are still a significant number of patients missing appropriate care. The use of beta-blocker medications for heart failure improved from 41 percent of appropriate times to 65 percent. Still, over one-third of patients miss out on this medication that has proven to lower the rates of death from heart failure.

The use of cholesterol medication, known as statins, in patients who have had strokes, improved from 34 percent to 57 percent. Perhaps a reason to celebrate, but still only a little more than half of eligible patients received the medication that they need to prevent more strokes.

What have patients been receiving?

Well, after standardizing the methods of their analysis, the Harvard researchers determined that patients are having a better experience when they go to see the doctor. The numbers of eights, nines and 10s on a 10-point scale increased. Patients feel that their doctors communicate more effectively, that the access is improved and that their doctors are spending enough time with them.

However, that does not translate into better care.

Doctors might be making patients feel more satisfied, but that won’t make people healthier. One-in-four eligible American adults does not get the appropriate cancer screening, diagnostic or preventative screening or diabetes care. Sixty percent did not receive the appropriate cardiovascular or pulmonary therapies.

This will lead to a greater overall cost to the health care system as more of these people end up with advanced disease or have complications resulting in prolonged hospital stays.

Medical guidelines are only as good as the numbers of doctors and patients who follow them. The study did note that a greater investment in primary care is needed to accomplish these goals.

Currently primary care spending is only 6-8 percent of all medical expenditures, and yet the only way to improve the quality of care is to provide a comprehensive source of consistent, coordinated care. This does not happen when patients seek emergency care or go to urgent care centers for their routine medical needs.

Despite all of the efforts to improve the quality of health care delivered in the United States over the past decade, the results show that not much has changed.

Better health care is endlessly more important than whether or not the doctor is nice or talks well. That’s a bonus, but it’s not a substitute for the use of the right medications and tests to keep patients healthy.

In the end, anything less will cost more money, and ultimately, more lives.

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