Ezra Klein: “There’s more than just guild greed at work. Methods of rationing, like capitation, are a hard sell to voters who want to believe they’ll get not only every treatment they could plausibly benefit from, but quite a few they couldn’t plausibly benefit from. In general, patients have a Samuel Gompers attitude towards medical treatment: They want more. Doctors don’t make much money when they prescribe unnecessary antibiotics for colds. They do it because patients want antibiotics — they feel better knowing something has been done.”
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Another issue with this is that if patient does not trust a given treatment he will not get better. Perceptionally. It is tricky to balance patients expectations and limited treatment. I think a thorough explanation and a good rapport with the patient should help.
I was in charge of a dependents clinic for a time during the Vietnam War. We had tremendous numbers of wives to children to see and not enough doctors, nurses or appointment slots. Every new doc (they were all draftees like me, and some were not happy campers) was a source of concern- would he (we had only male MDs) be able to handle the crowds, keep calm, avoid getting us written up, etc.
There was one special doc. Within a day or two of his arrival, the nurses were telling me, “Dr. P is really something. He gets them out fast and they come out smiling”. We all ate lunch together in our little clinic. The next day, I asked Dr. P, “What is your secret?” He said, “Well, I’ve been around in other busy clinics. I know that people want a prescription. I don’t sit down or waste time. When they walk in, I’m all smiles and I have my prescription pad right in my hand. I ask, ‘what do you think you need?’ I don’t always prescribe what they want, but I try to; I know that it’s quicker to give them something than to waste time with long explanations”. We never had a single complaint about Dr. P, unlike some others of our physicians.
I think fewer patients would go to the doctor for their colds if they had to pay the full price for the visit and the antibiotic.
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