Eyeworld

56 | EYEWORLD | MAY 2019 G UCOMA PRESENTATION SPOTLIGHT Contact information Tuulonen: anja.tuulonen@pshp.fi by Stefanie Petrou Binder, MD EyeWorld Contributing Writer cal developments, where do we draw the line? And even if an individual patient is treated with what is thought to be top-of-the-line treatments and technologies, would it be at the expense of another patient who might benefit much more from the same resource? If and when the same money cannot be spent twice, who decides? One way to explain it would be to say that we are trying to do too much. "There is a widely ignored issue with overdiagnosis and overtreat- ment. Simply delivering more tests and care does not provide improved well-being, espe- cially if the diagnosis is unwarranted. I would also like to challenge the thinking that giving a diagnosis makes a patient happy. We should be focused on the patient's well-being, reserve our resources for those who need it most, and avoid overdiagnostics," she said. Targeting patient well-being One definition of well-being hits the mark best: the ability to adapt and to self-manage in the face of social, physical, and emotional chal- lenges. According to Dr. Tuulonen, healthcare alone accounts for only 10 to 20% of improved well-being in the western countries. Other factors that contribute to a person's well-being include education, income, consumption pat- terns, roads, and clean water, to name a few. She suggests that if we are overspending on health- care, we might counterintuitively influence other factors responsible for well-being. "As doctors, we try to produce the best possible well-being within an affordable health- care system. Although it seems very simple, there are many things to consider in the real world. Measuring well-being involves develop- ing an instrument that is not overly sensitive, but sensitive enough to pick up differences in health-related quality of life, e.g., in early glau- coma. However, too many specialized question- naires with too many questions will overburden patients and undermine response rates," she said. The 15D instrument of general health-re- lated quality of life creates a health profile using S imply delivering more healthcare services does not guarantee well-being. Considering access to adequate and equal health services, Finnish ophthal- mologist Anja Tuulonen, MD, said it is time to embrace "good enough" as the new optimum. "We are all both tax payers and patients, and in these roles, we might have different preferences. No one wants to pay more taxes, but as patients we think that we have the right to receive all available services. But who has the power to decide what is 'best' both for the individual patient and the society? In a world of finite resources, how can we share the cake equally and cost-effectively?" Dr. Tuulonen said at the 36th Congress of the European Society of Cataract and Refractive Surgeons. The conundrum One might say that amping up the healthcare system through higher taxes or taking on debt would solve all problems and improve well-be- ing. Real-world scenarios speak to the contrary. "There is much evidence that western countries spend more money on healthcare than ever before, produce more services than ever before, people are healthier and live longer than ever before, however, these come along with even higher demand and exponential increase of costs," she said. If the available resources cannot keep up with the rise in new interventions and techni- Patient preferences and costs The Finnish perspective About the doctor Anja Tuulonen, MD Director, Tays Eye Centre Tampere University Hospital Tampere, Finland Reference 1. Hagman J. Resource utilization in the treatment of open angle glaucoma in Finland: an 11-year retrospective analysis. Doctoral dissertation. University of Oulu. 2012. Financial interests Tuulonen: None continued on page 58 "As doctors, we try to produce the best possible well-being within an affordable healthcare system. Although it seems very simple, there are many things to consider in the real world." —Anja Tuulonen, MD

• Blank Page
• Blank Page (1)
• Blank Page (2)