The Top Five

My husband and I, when we were first dating, used to play the "top five" game. You know, when you ask each other for your top five books, movies, teams, songs, bands, etc. It was a great way to get to know each other and the game served to ease us through the awkward "chatting with you over dinner before this bottle of wine kicks in" phase. (so glad that's over!) In fact, we just played this game and listed our respective top five Stephen King novels (over a bottle of wine coincidentally). I happen to be a huge fan of the author and my husband, well, was more of a fan in junior high than now. But we can't all be highbrow with our literary leanings.

There was recently a fascinating editorial published in the New England Journal of Medicine regarding "top five" lists. The premise is this:
The Top Five list would consist of five diagnostic tests or treatments that are very commonly ordered by members of that specialty, that are among the most expensive services provided, and that have been shown by the currently available evidence not to provide any meaningful benefit to at least some major categories of patients for whom they are commonly ordered. In short, the Top Five list would be a prescription for how, within that specialty, the most money could be saved most quickly without depriving any patient of meaningful medical benefit.

Working in a neonatal intensive care unit, where we routinely keep babies alive artificially and often for great lengths of time, I witness firsthand the miracles of medical technology. And the failures. And the ethical dilemmas. And the extraordinary costs of doing things because we can. I also witness my friends in general pediatrics working long hours and fighting everyday to spend enough time with their patients and families under the constraints of billing and 'moving them through'. It's no secret that the 'doing' specialties are reimbursed far more than the 'talking' specialties. Technology pays. An interesting spin on the healthcare reform debate...