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Published: 7/16/2001

If medicine is better, why are we seeing doctors more?

Talk about medical mysteries. Here's one to stump Sherlock Holmes, Nero Wolfe, Hercule Poirot, and a squad of other fictional detectives:

How on Earth can Americans feel sick more often today than they did 40 years ago? Why do they visit the doctor's office almost as often in 2001 as they did in 1961, and need hospitalization about as frequently?

Think of all the advances in medicine since the early '60s: Hundreds of revolutionary new drugs that keep diseases from getting worse and make people feel better. Ways to prevent disease by controlling high blood pressure, high cholesterol, and other risk factors. The healthy lifestyle bandwagon that has millions of people exercising, eating better, watching their weight, and throwing away their cigarettes. New vaccines that prevent infectious diseases and antibiotics that cure them. With all this progress - and much more - shouldn't people need a lot less doctoring?

That riddle emerged in June, when Dr. Larry A. Green and a team of other researchers updated a famous 1961 study. He is with the Robert Graham Center, a Washington think tank devoted to health-care issues.

Entitled "The Ecology of Medical Care," it estimated the number of people in the community who get sick every month and seek medical care in doctors' offices, hospitals, and other places. Policy-makers have used its findings for more than 40 years as a framework for decisions about providing medical care, educating doctors and other health care professionals, and doing medical research.

The original study concluded that for every 1,000 people in a community, an average of 750 experience symptoms of illness or injuries each month; 250 consult a physician one or more times per month; 9 are admitted to a hospital; and 1 is admitted to a university medical center (where the most serious illnesses may be treated).

Dr. Green's group decided to update the study with new data that might serve as a 21st-century framework for health-care policy makers. The new study concluded that for every 1,000 people in a community today, an average of 800 report symptoms of illness or injury each month; 217 visit a physician; 8 are hospitalized, and 1 is hospitalized in a university medical center.

In addition to the 217 who see a physician, 103 get care in elsewhere, such as hospital emergency departments. That brings the number who get professional care each month to 320 - more than the comparable 1961 figure.

An additional 317 people feel sick enough each month to think about going to the doctor, but don't.

Differences do exist between the two studies, both of which were published in the New England Journal of Medicine (NEJM). The 1961 version, for instance, was limited to individuals age 16 and above. The 2001 version included people of all ages, and was based on better statistical data about use of medical care.

Dr. Green labeled the findings "remarkable," but noted that the study did not investigate why people still feel sick so often.

A NEJM editorial suggested that many modern patients go to the doctor not just for illness, but to get information. "Patients want to know the meaning of their test results, the side effects of their medications, the implications of a report that was in the news, the worst possible disease that could be the cause of a symptom that began that day. "

But doctors still provide information much like their 1960s-era peers - mainly in office visits. NEJM suggested that insurers could reduce office visits during the next 40 years by reimbursing doctors for e-mail and other communications with patients.

Michael Woods is The Blade's science editor. His column on health and medical issues appears each Monday.



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