A simple question can greatly impact health care costs:
Millions of such conversations would be useful, given the tremendous amount of wasted care in American medicine. Patients get tests and treatments they really do not need because they don’t know better (resulting in antibiotics for viral colds, for example), because our physicians are paranoid about being sued (resulting in defensive X-rays and other tests), and because many physicians and patients ignore guidelines suggesting when some tests and treatments can be avoided.Money is another key reason for unnecessary tests and treatments. The majority of patients do not pay for all of their health care, providing them some protection from the financial ramifications of unnecessary tests and treatments. Why shouldn’t I have an ankle X-ray just to be sure I don’t have a tiny fracture if it doesn’t cost me anything? Perhaps as important, no one providing health care gets any revenue when a test or treatment does not get done, which means the business model of health care benefits from all testing and treatments, regardless of the benefit to the patient.
Fear also plays a role. If a test or treatment is not done, the patient may be unhappy or be harmed by a missed diagnosis, and the physician might get sued. By comparison, a test or treatment that costs money but seems unlikely to cause harm is a small price to pay.
Related posts:
- How much unnecessary testing goes on in the ER?
- Defensive medicine in the news
- Unnecessary tests vs bankruptcy
- The unintended consequences of free HIV screening at hospitals
- Continuity of care
- Patients still trust their doctors, and how that can influence health reform
- Unnecessary workup in the emergency department
{ 10 comments }
Don’t people go to professionals because they don’t know what they need? And don’t those professionals only bill for charges they deem are necessary?
That’s a nice idea, in theory. But like so many things, it just doesn’t work in the real world. Mostly because a small percentage of the population sucks, and ruins it for everybody else. In this case, it’s the sue-happy waste products that look at every bad thing that happens as a means of getting rich.
I suggest you read Kevin’s post about defensive medicine to give you a better idea of how it all works, and more importantly, why.
In my last visit to my doctor, I would have been asking the question to the tail of his coat as it rapidly swished down the hall. In and out before I knew what was happening. $150.
In my family, it isn’t the doctor who is driving the testing but the patients. They are totally enamoured with medical technology, being thorougly dissatified with any doctors advice until they see a high res MRI picture to back it up. Of course they are all double and triple insured.
“Don’t people go to professionals because they don’t know what they need? And don’t those professionals only bill for charges they deem are necessary?”
..No? To cite one very small example, almost all inappropriately prescribed antibiotics are prescribed at the demand of the patient. Attempting to argue peer reviewed journal articles showing no decreased length of illness goes nowhere. Withholding antibiotics that the patient wants means you are an “arrogant doctor” of the sort you complain about incessantly, undoubtedly of the sort that leaves the room with “the tail of his coat rapidly swishing down the hall”.
“I suggest you read Kevin’s post about defensive medicine to give you a better idea of how it all works, and more importantly, why.”
It’s the same old, same old. Physicians blaming someone else for their ills, when they should be looking at themselves.
Over the past 5 years, purely as the result of “preventative” visits to my doctor and dentist, I’ve been biopsied twice, undergone minor (skin lesion related) surgeries seven times, and put on medications for high cholesterol and hypothyroidism.
In no case did any of the doctors discuss options. It was “we’re going to do this.” After the 5th skin lesion surgery I began looking researching options myself and, like “they” always recommend, went to the next appt with specific questions about alternative treatments.
The surgeon just said “That doesn’t work” (literally, that was the extent of his response) and continued filling out the paperwork for another surgery.
You can point the finger at malpractice/defensive medicine all you want, but if you’re not going to give your patients any options, you’re directly responsible for contributing to the problem.
…but if you’re not going to give your patients any options…
Options?
You come to me for my opinion. Based on experience, and knowledge of the current litarature I make a recommendation. I may (rightly) believe that there are no other “options” that are any better than doing nothing at all.
I’ve encoutnered this in my practice – “I don’t want to do that Doc, you have to suggest something else,” or “I don’t want to try that because I read about this side effect…” or “my brother-in-law’s third cousin says that treatment causes liver damage.”
I am sorry, you asked for my opinion, and I gave it. Your dissatisfaction with my professional opinion does not compel me to practice poorly.
Of course, if there is nothing appropriate to offer as an “option,” I could make something up. How about it?
You’re right. But if that’s your opinion based on your professional training and experience, stand by it. Don’t come crying about how “the lawyers made me do it” later.
If you don’t have the stones to stand by your professional opinion, then give the patient the option to choose.
Your retort begs the question:
Choose from what?
And, for what it’s worth, I DO stand behind my professional opinion. I have been to court to defend it.
This is little consolation, though, for those patients who insist that there must be a better “option” and that I am wihtholding it from them for “selfish” reasons. They could not care less that I stand by my opinion, that it is a professional opinion, or that I am a professional. They only want reassurance that their misguided self-treatment is appropriate.
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