[Editor's note: This story originally was published by Real Clear Health.]
By Marschall S. Runge
Real Clear Health
American health care, like American society, often attempts to solve problems with more – more tests, more medication, more access options – you name it.
We embrace this mindset in large part because it works. It has helped us make great advances in the development and delivery of care. But it has also blinded us to seeing how another approach – the idea that less is more – can also help us improve medicine. COVID-19 may be helping us to remove these blinders.
At Michigan Medicine, as the first wave of COVID-19 surged last spring, we built a new unit by converting space in the children’s hospital, with more isolation rooms and ICU capabilities to handle the influx of sick and contagious sufferers. We did this in record time, and we are justly proud of this accomplishment.
But when the third wave of COVID brought high numbers of patients in April, we did not reconstruct our surge unit. We didn’t need to, because we found a better way: making precise adjustments with our existing space.
I had not considered the larger issues reflected in these two decisions until reading a recent article in the journal Nature about the human tendency to solve problems by assuming more is better – which is what we did during the first surge. Our later response highlighted the less can be more approach that may be one of the most significant lessons of COVID-19.
The Nature article reported on experiments that showed how people almost instinctively seek to solve problems by adding new features instead of subtracting existing ones.
“Our studies showed,” the authors explained in a separate Washington Post op-ed, “that people’s first instinct is to change things by adding. When they are able and willing to think a little longer, they are perfectly capable of finding subtractive changes. But they usually don’t think longer.”
That’s one reason the same set of buzzwords - “efficiency,” “economizing” and “cost control” – have loomed over our business models for decades, like a desert mirage we can see but never reach. Our efforts to scale back are often overwhelmed by the lure of more. We believe more hospitals and clinics will improve patient care; more tests will identify more illnesses; more medicines will improve treatment; and more money will make everything else better.
One of the starkest examples is the swift and expansive embrace of telemedicine. The medical community had recognized its benefits for years, the time it saves patients and caregivers while reducing the strain on precious resources at hospitals and clinics. But a profound resistance to change blocked its adoption, creating the need to build new, expensive facilities.
Michigan Medicine, for example, held 444 virtual appointments in February 2020, the month before COVID struck with force. That November we had more than 34,000 virtual appointments.
Those numbers have remained steady, indicating a momentous and enduring transformation in the delivery of care. It is still too early to assess the long-term impact, but the rise of telemedicine promises to greatly reduce future needs to build more facilities while vastly expanding the access to care, especially for those who find it hard to arrange local travel or live in rural areas.
COVID-19, which has had an especially devastating effect on those with underlying medical conditions, is also pushing the medical community to rethink its more is better approach to human health. Although many diseases have a genetic component, lifestyle behaviors are significant contributors to the prevalence of obesity, diabetes, hypertension and heart disease that made so many people vulnerable to COVID-19.
The NIH reports that Americans consume far too much ultra-processed food, which can lead to overeating and weight gain. The CDC says that just “one 1 in 4 US adults and 1 in 5 high school students meet the recommended physical activity guidelines. About 31 million adults aged 50 or older are inactive, meaning that they get no physical activity beyond that of daily living.”
Too often, the medical community waits until people become sick and then provides treatment. This often results in a more-is-better approach as we add tests, treatments and medications on top of each other. Studies have found that more than a third of Americans over 65 take five or more medications.
COVID-19 has underscored how this can leave people vulnerable to disease. Instead of just adding new medicines, caregivers must redouble our efforts to limit the unhealthy habits that require treatment.
The less-is-more ethos is not a panacea for the challenges we face. In many cases, more really is better. But as the authors of the Nature article and our experience with COVID suggest, as we strive to deliver more affordable, higher-quality health care, sometimes we can make powerful additions through subtraction.
Marschall S. Runge, MD, PhD, is Executive Vice President for Medical Affairs and Dean of the Medical School for the University of Michigan. He serves on the Board of Directors for Eli Lilly and Company.
[Editor's note: This story originally was published by Real Clear Health.]
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