EP449: For Clinical Leaders, Payers, and Plan Sponsors, Let's Talk About Blind Spots for Getting Patients or Members Appropriate Care, With Marty Makary, MD, MPH

Stacey Richter had a chance to read Dr. Marty Makary's new book, Blind Spots, and invited him back on Relentless Health Value to talk about something he said on page 127: the idea of what is appropriate care and how good the industry actually is at ensuring patients and members get it. Appropriate care has come up repeatedly on the show — with Ben Schwartz, MD, MBA (EP434); John Lee, MD (EP438); Spencer Dorn, MD, MPH, MHA (EP446); and Tom Lee, MD (EP445). An estimated 21% of all medical care is potentially unnecessary, per a national survey of physicians: 25% of diagnostic tests, 22% of all medications, and 11% of all procedures are unnecessary or inappropriate — billions of wasted dollars doing stuff that shouldn't be done. Dr. Makary and Stacey delve into the challenges of ensuring patients receive appropriate care, touching on medical dogma, financial, business, and legal incentives, and the importance of measuring practice patterns. Dr. Makary provides practical advice for clinical leaders, payers, and plan sponsors on promoting transparency, improving health literacy, and steering members toward higher-performing providers.

WHAT YOU'LL LEARN

✅ What "appropriate care" actually means, and why an estimated 21% of all medical care may be unnecessary

✅ Why medical dogma and absolutism get in the way of patients receiving appropriate care

✅ How groupthink shows up in medicine, and why providers resist new ideas even in the face of good evidence

✅ Why "if you leave it to the medical profession to fix itself … so far, it's not going well" — and what has to change instead

✅ Practical advice for clinical leaders, payers, and plan sponsors on promoting transparency, health literacy, and steering members toward higher-performing providers

WHY THIS MATTERS

"People need to find their care based on quality and price." Dr. Makary's argument isn't that providers are acting in bad faith — it's that medical dogma, financial incentives, and legal exposure combine to make appropriate care surprisingly hard to define and even harder to deliver consistently. Fixing that requires transparency and measurement, not just good intentions.

=== LINKS ===

🔗 Show Notes with all mentioned links: Episode Page

🔗 Healthcare Industry Acronyms and Terms

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00:00 Introduction.

07:32 What is appropriate care?

10:19 Why what we think might be appropriate care might not be appropriate care.

10:34 Why is medical dogma damaging to appropriate care?

12:45 Why we need less absolutism in medical practice.

13:37 How is groupthink prevalent in medicine?

14:02 Why do we resist new ideas?

17:43 How do providers figure out what to believe and what not to believe?

20:59 "If you leave it to the medical profession to fix itself … so far, it's not going well."

22:33 How does supporting health literacy affect appropriate care?

30:23 "People need to find their care based on quality and price."

34:28 What proportion of medical care is deemed unnecessary right now?