What a Waste

February 2026 | Vol. 70, No. 1
By Joseph Zawisza, DO, PCOM '05

Whether we like it or not, Medicine is a business, no doubt about it. A quick Google search indicates that the US healthcare market was valued at $4.87 trillion in 2025 and will increase to $5.15 trillion this year. Furthermore, in 2020, healthcare spending accounted for 19.7% of the U.S. economy, and currently, the healthcare sector employs over 20 million people in the United States.

As a solo practitioner, I realize that my primary care private practice makes up the most minuscule slice of the healthcare pie. What makes up a much larger slice of the pie is wasteful spending. One of the not-so-well-kept secrets in Medicine, the amount of wasteful spending is enough to give you chest pain, which will be followed by an EKG, cardiac enzymes, a stress test, a nuclear stress echo, electrolytes, a urine drug screen, an upper GI series, PFTs, a CT scan, and probably a colonoscopy, “just to be safe” of course. A 2019 study published in JAMA (Waste in the US Health Care System: Estimated Costs and Potential for Savings, William H. Shrank et al.), which reviewed studies in healthcare waste published between January 2012 and May 2019, determined that the annual wasteful spending in healthcare ranged from $760 billion to $935 billion. The potential savings from interventions that address waste were $191 billion to $286 billion. I think it is safe to say those numbers will be much higher in 2026.

So how can we, as one person, control these beyond astronomical numbers? One of the problems that I see that contributes to wasteful spending is providers and healthcare systems relying too much on electronic medical records, protocols, and algorithms to deliver healthcare instead of using our brains. Although I generally despise the use of the term provider because it denigrates my training as an osteopathic physician, the problem truly can be attributed to anyone who has a pen and prescription pad, which later became a COW (computer on wheels), and after a few other reinventions, is now as simple as signing orders on your cell phone. I fail to see how that shows you the “big picture” of the patient’s chart, literally. By not actually writing out the order by hand, talking to the computer instead of the patient, or just clicking “compare” in the EMR for whatever results are there, rather than seeking out the results important to the patient’s care, we inadvertently create a great deal of waste. And that doesn’t even start to cover the topic of examining the patient versus doing a test instead.

Recently, a family member of mine, whom I happen to take care of as a patient as well, was admitted to the hospital for a diverticular artery bleed. This was successfully treated, and he was admitted to the ICU for the night to monitor his acute anemia, among other things. The next morning, he was moved out of bed and into a chair. Great! Except he soon developed a dysphasia. We got him back into bed, laid him flat, and it almost immediately resolved. Although the senior resident assured me it was certainly caused by hypoperfusion from being upright, a CT was ordered to rule out a stroke. But in order to make this happen in a timely manner, a stroke alert had to be called. I understand there are protocols, however the stroke alert necessitated transfer to the Neurological ICU for at least 24 hours. In addition, because no test is completely accurate, there was a debate over whether a thrombolytic should be started on a patient who, less than 24 hours earlier, had a life-threatening hemorrhage, which required twice as many specialists on the case as had already been involved. Ultimately, it was started, which required two nurses to monitor him for a period of time rather than just one. Then I met the physician assistant who would be taking care of him in the Neurological ICU; I had foolishly thought that what was now such a complicated case would warrant the expertise of an attending physician, maybe even one who was fellowship trained in Critical Care or Neurology. Don’t worry, they were there in spirit, or at least on the itemized bill after his stay. As the final insult, the PA told me that my patient hadn’t had an A1c to monitor his diabetes in over ten months. This puzzled me since I personally had ordered and reviewed an A1c every 3-4 months, and knew they showed good control. Her reason? “It’s not in the system.” I pulled up his chart and started giving the results of the past year. She explained to me that she was looking at his chart right now, and he clearly hadn’t had one in ten months, so she would be ordering one. Informing her that I was also looking at his chart, which simply did not communicate with her EMR, I demanded that she come look at my computer and see his results because her behavior was insulting.

In the end, she ordered an A1c anyway, and you are probably not surprised that it differed from the one he had just had done two weeks earlier by 0.1%.

Of course, we all want the best for our patients, and especially for our family members. But misuse of technology and faulty reliance on systems, disguised as providing better care, too often get in the way of that.

So don’t worry. The business of Medicine is doing fine. Medicine, sadly, is in trouble!