Editor's Memo

Utilization: Eye of the Beholder

John Marcille

You've got this little nagging pain in your shoulder, but sometimes it's more than just a "little" pain. It's a big pain. In the shoulder. You've had to reach for the aspirin bottle a few times and that's saying something, considering how your eyes have been so irritated lately you can hardly see. More than irritated, in fact. Real scratchy. And speaking of scratching, you've been bothered by what you thought is a mosquito bite on your ankle but now, you don't know, because it's looking more like a lump and there's a rash all around it and that's not just because you've been, well, scratching it.

You ought to make an appointment to see your primary care physician. If you want to gamble on waiting that long, that is. If I were you, I'd call an ambulance right now. Relax. You can read something while you wait. There's a story here, for instance. It's all about the worried well.

Who are they? (Are you sure two aspirin are enough? Two might help that pain in the shoulder, but what if you're having a heart attack? Is it too late to start on baby aspirin?) They're the people who think they're sick, but who are actually as healthy as....

That's right, they utilize a lot of services that they don't, strictly speaking, need. They're a little bit difficult to pin down, though. They have a lot of psychosocial distress, but not so much that they qualify for a psychiatric diagnosis.

David S. Sobel, MD, MPH, the director of patient education and health promotion at Kaiser Permanente Northern California, says that as a "result of their worrying, they're actually sick, meaning they're experiencing symptoms and they're suffering." There are ways to combat this problem, he says, and describes some.

Look, there's no silver bullet to tame health care inflation. We need to chip away where we can, and while the worried well deserve our attention, we do have the opportunity to trim some utilization without hurting them in any way, if we are sensitive about it.

Elsewhere, there's an interview with another physician — Howard Dean, MD, the former governor of Vermont who's running for president. Of the United States. Has ideas about how health care should be run. Looks healthy too. Not bullish on managed care, though.


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