August 2, 2011
Spirometry is a powerful tool for the diagnosis and treatment of both asthma and COPD (http://livewellthy.org/2011/03/02/chronic-obstructive-pulmonary-disease.aspx). Many years ago, while serving on a national advisory board for the treatment of Asthma and COPD, I met a brilliant teacher whose passion was Spirometry. He sold me on the diagnostic value of this relatively easy, inexpensive, and harmless test; and I have been using it in my practice ever since.
MedPage Today just posted an article, “Physician Groups Issue New COPD Guidelines”. Three of the most prestigious medical organizations, the American College of Physicians, the American College of Chest Physicians, and the European Respiratory Society were quoted as saying:
“Spirometry shouldn’t be used to screen for airflow obstruction in patients without respiratory symptoms, even at-risk patients such as smokers, they said. This could lead to unnecessary testing, increased costs, and unnecessary disease labeling.”
“Both of these are strong recommendations backed by moderate quality evidence, they added.”
While I try not to delude myself into believing that I, Stewart Segal, M.D., is smarter than these three respected and learned societies, I can only say “BS!”
How can you make such a “strong recommendation” on “moderate quality evidence”? The answer is easy! Their recommendation is based on cutting the cost of medical care by deeming anything that carries an expense and is not absolutely necessary as “unnecessary testing”. I fear we will see much more of this type of cost cutting garbage in the near future.
Please, let’s not brand someone as having mild COPD! Think what that stigma will do to the poor guy’s mental status! Let’s wait until he needs oxygen before we let him in on our little secret. COPD is the 3rd/4th leading cause of death. I thought President Obama’s healthcare reform bill did away with the financial risk of being diagnosed with a disease and opened the door to a frank discussion about the consequences of having COPD, pre-diabetes, and elevated blood pressure.
These learned societies are watching out for the emotional wellbeing of my chronic lunger and I’m the meanie whose labeling the poor guy. BS!
By doing an inexpensive, pain-free, risk-free exam in my office, I can actually show my patient objective proof of what is happening to his lungs. I actually have a chance to get him to quit smoking. I have a chance to convince the painter to wear a respirator. I have a chance to make the patient with his second “cold” this year understand that it is not just a cold.
What these three prestigious societies have done is given the insurers of America a reason to refuse payment for yet one more valuable diagnostic tool. What these societies have done with their infinite wisdom is to further enrich the Goliaths of the industry while sacrificing the wellbeing of my patients. This is a very sad day indeed.
I have a “strong recommendation” based on 28 years of practicing medicine (considered weak quality evidence); we ignore the BS edicts that redefine medical practice based on medical economics and stop giving gifts to the almighty insurance companies.
Remember, necessary and unnecessary are incredibly subjective terms best decided on an individual basis (http://livewellthy.org/2011/02/10/doc-do-i-need-that-test.aspx). Early diagnosis gives my patients a chance to change their habits. Early diagnosis gives my patients the opportunity to learn what the future may hold for them and a chance to change their future. Early diagnosis gives the hope for future treatments and cure.
Shame on the academics for closing one more door. When we forsake the individual for the greater financial good, what have we done? What we have done is hasten the demise of our patients by covert rationing (http://covertrationingblog.com/).