1. WASTE: I used to cringe in the operating room when I witnessed packages after packages of sutures opened by mistake and then discarded. Some hospitals salvaged these and sent them to third world countries for re-sterilization and subsequent use. Many other items which were disposable and opened by mistake were likewise wasted. This is just an example of the waste which goes on all over a hospital and is magnified by the same thing happening all over the country. The cost mounts up and is significant.
    
2. DUPLICATION OF PROCEDURES: Time after time, I used to see tests unnecessarily repeated when patients were transferred to other institutions or referred to other doctors. Better communication and perhaps electronic record transfer could reduce this. The sad thing is that many times the other institution or physician gives a lame excuse and repeats the procedure so that they can reap the benefit.
    
3. UNNECESSARY IMAGING: This could perhaps be under no. 2, but it is so large, I think it deserves a separate category. Billions of dollars are spent each year on MRIs, CT scans, and other imaging procedures. Some of these are not needed and others are duplicated unnecessarily. In some cases they are done on outdated or inferior equipment and must be repeated for adequate quality.
    
4. MEDICARE READMISSIONS: A recent study demonstrated that this amounted to a significant sum of money. This should be correctable.
    
5. MEDICAL CARE AT EITHER EXTREME OF LIFE: Premature babies by unwed mothers who do not seek prenatal care cost a significant amount of money to care for and then continue to drain medical resources and funds. The extreme elderly who are sent to ERs by nursing homes and family members and then are admitted to the Intensive Care Units only to expire just as they would have in a more serene setting, cost Medicare billions of dollars each year.
    
6. INAPPROPRIATE EMERGENCY ROOM CARE: Too often patients go to the ER for problems which could have been handled just as well or better in a doctor's office. It is sad to say that this is not always the patient's decision. For instance, this horror story just recently came to my attention. My former Internist and good friend who is now retired told me of a situation which he was involved with. A good friend who suffered from chronic congestive heart failure contacted him because her son was out of the city and she was having an exacerbation of her problem. My friend, the doctor, took her to her cardiologist's office. That group was one of the largest and supposedly respected cardiologists in the city. Her cardiologist was not in the office, so his nurse saw the patient and suggested that she go to the ER. My friend asked the nurse if one of the other cardiologists could see her (there were 5 there that day). She said for some reason that would not be possible. So they went to the nearby ER and proceeded to wait hours for attention. Finally, the ER doc saw her and said yes, she needed to see a cardiologist. A call went in to her cardiologist and they waited longer. In the mean time, my friend kept calling back to the office trying to talk to one of the cardiologists. When the patient's cardiologist finally got to the ER, he proceeded to "chew out" my friend for disrupting his office. He treated the patient and sent her home. Her purse and Medicare's wallet was much lighter as a result. Besides the unnecessary additional expense, I ask you; Was this good medicine? No, it most certainly wasn't! Unfortunately, this scenario is currently not unusual and this is one of the many things wrong with American Medicine today.

Medicine is like a woman who changes with the fashions.
     - August Bier (1861-1949)

Nature, time, and patience are the three great physicians.
     - Bulgarian proverb

Medicine can only cure curable diseases, and then not always.
     - Chinese proverb

If every man would mend a man, then all the world would be mended.
     - Anonymous