1) “Thoroughness” is the most desirable characteristic patients want in their doctor.
My take: Sandeep Jauhar finds this to be true when talking to a cardiologist:
A young woman would come in with palpitations. I’d tell her she was fine. But then I realized that she’d just go down the street to another physician and he’d order all the tests anyway: echocardiogram, stress test, Holter monitor “” stuff she didn’t really need. Then she’d go around and tell her friends what a great doctor “” a thorough doctor “” the other cardiologist was.
Doing more, possibly unnecessary, testing is generally perceived as being thorough. American physicians are increasingly being rated and graded, incentivizing doctors to pander to customer service and patient satisfaction over practicing evidence-based medicine.
With thoroughness being the top patient priority, it’s not a stretch to say that many physicians who order unnecessary testing are doing so because that’s what the patients want.
You could Dartmouth Atlas your patients’ ears off, but who’s going to listen?
2) Females are taking exception to being blamed for Canada’s physician shortage.
My take: This is more of a generational, rather than female, phenomenon. Plenty of men want to spend more time with their families, and in general, are working less hours than their predecessors did. As it should be. The days of sacrificing your life for medicine are over.
Related posts:
- Female physicians and the Canadian doctor shortage
- Finding less intense care is difficult
- The attack on female physicians continues
- Female vs male physicians
- Health care policy experts versus the public, an obstacle to reform
- Are emergency physicians best served to staff urgent care centers?
- JCAHO: Harming patient safety?
{ 8 comments }
What a terrible politically correct puff piece on the female physician issue. The reporter constantly dodged around the question of actually asking “Do women work significantly less” because it wouldn’t have given the desired point. Surprise surprise!
Patient’s desire for thoroughness comes from lack of knowledge of 1) risk of testing 2) that detecting something early doesn’t always make a difference.
This perception comes from years and years of overtesting and advertising by physicians. Rather than automatically assume that all patients want testing, how about asking if someone really wants a test? BTW – I switched an ObGyn because the previous one wanted to do yearly ultrasounds for no symptoms and no reason at all; I also stopped going to physicals because of all unnecessary tests this entails. Maybe an average person wants extra tests, but a lot of people aren’t average. How about quantifying the chance that a test will find something and explaining the risks of the test?
Additionally, blaming everything on insurance’ paying doesn’t take into consideration the fact that most companies nowadays are switching from HMOs with everything covered and fixed co-payment to PPOs with 20 or 30% co-insurance and high deductibles. Ordering an unnecessry test without explaining benefits and risks and then charging for it is stealing unless a) the patient wants the test b) understands the probability of benefit and risks and c) knows the cost.
I don’t see what the big deal is. Women and men both work less. This is true, BUT women work substantially less. Most men in my medical school class (graduated 3 years ago) planned on having a full career with about 50-60 hours a week. Most women were already planning on working less than 40 through job splitting. Some were not even planning on working at all! That was amazing to me!
Quantifying the value and risk of a test is a very appropriate question. We’d be better off as a society if more people asked these questions at their annual exam.
Unfortunately, I’m so squeezed for time at office visits by the low insurance and govt. payments that I could never regularly explain this for each of the numerous screening tests to consider.
Does anyone know of appropriate patient friendly web sites that explain this well? I found the USPTF site to be too physician orientated.
“Does anyone know of appropriate patient friendly web sites that explain this well? I found the USPTF site to be too physician orientated.”
Personally (I am anon at 11:43) I like USPSTF, but most people don’t want this much detail. NIH/PDQ web site has information about some cancers, but unfortunately the best information that includes incidence, probability and such is in their “health professional version”.
Welch’s “Should I be tested for cancer” book provides a good explanation why more testing != better health. It is an easy read and a source for possibly simple explanations. A lot of what he says applies not just to cancer but to other tests as well. Some doctors may find it interesting as well given how many of them (judging by TV adds and TV-doctors’ advice) don’t seem to understand lead-time bias. But.. he also points the downside to recommended tests.
I don’t know if a lot of time is really needed. How long does it take to say “I think you are very unlikely to have X, and the risks of CT scans include, but ,,,”.
Just presenting a test as a choice would help. A lot of people find it difficult to refuse a test even if they don’t want it. Even those of us who are relatively well informed about which tests are definitely NOT recommended, are a bit intimidated to say “NO” to a doctor.
How about a printed handout listing recommended tests for each age, with a couple of sections on most commonly asked for non-recommended tests and why they aren’t recommended?
How about the crazy notion that someone who works less and has something that approximates a family life might be a better practitioner?
Do you want to take your kid to a doctor or therapist that doesn’t have a family or never sees them? Do you want to take your parent to a Cardiologist who ignored his/her own old parents because he/she was working all the time?
I’m not sure the “good ‘ol days” were really that way.
“Do you want to take your parent to a Cardiologist who ignored his/her own old parents because he/she was working all the time?”
That’s exactly the kind of doctor I want for myself or for my parents.
I, myself, want to be the type of doctor who has a life and doesn’t ignore his family.
The best remedy for patient’s demanding excessive testing is restoration of the doctor patient relationship. How much more willing would people be to accept their doctors reassurances without expensive pictures and printouts if
1) They picked their doctor instead of having them picked for them.
2) Their doctor was able to charge for his time instead of working in a CPT system that practically forces churning patients
3) The patient paid the doctor and so knew the doctor wasn’t working for who was really paying
4) The patients direct payment of the doctor reinforced the patients valuation of the doctor instead of devaluation with a tiny copayment
5) The patient was going to have to pay for those pictures and printouts a la carte instead of prepayment by insurance.
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