An editorial in JAMA by Donald Berwick, MD, speaks about the “existential threat of greed in U.S. health care.” He points his finger at all segments of health care, including physicians.
In my specialty of vascular medicine, I have encountered a number of physicians who blatantly and repeatedly urge their patients to undergo saphenous vein ablations even though these veins, by my examination, are completely normal. These are often patients who are poor and uneducated and thus are at the mercy of their physician’s unscrupulous behavior. Some of them have peripheral arterial disease and potentially could need these veins for bypass conduits. I have attempted to report one of the most egregious offenders to the Medicare fraud center, but so far, I have been unsuccessful in my attempts.
Then there are the cardiology colleagues that ordered annual nuclear scans on my patients—including those who were completely asymptomatic and did not meet any accepted indications for such scans. I finally began arming my patients with literature from Choosing Wisely to take to their next cardiology appointment. The annual tests were scaled back in a number of cases, but this exercise was stressful for my patients, who had to challenge the care of their own cardiologist and me. Incidentally, Choosing Wisely has an excellent white paper about how vulnerable populations are often the victims not of lack of medical care but of overuse, i.e., unnecessary and sometimes risky procedures pushed upon them by doctors with questionable ethics.
Multiple surveys show that physician income is not correlated with career satisfaction. One Medical Economics survey showed that pediatricians and psychiatrists, some of the lowest earners among us, nevertheless had the highest satisfaction levels. In contrast, orthopods’ satisfaction levels were at the bottom of the chart.
Historically, doctors have been in the top tier of the “noble professions.” This has been attributed to our care for others, our trustworthiness, and our indispensability to society. But if “greed” is added to this list of physician traits, we will quickly lose our noble status in the eyes of society and among ourselves.
We physicians must challenge greed wherever it rears its head, whether it’s pharmaceutical companies, insurance companies, hospitals, or members of our own house. I’m mostly retired now, except for volunteering in a clinic that serves the uninsured at no cost to them. If the upward trajectory of greed-fueled medical costs continues, more and more Americans will be forced to rely on similar clinics of last resort.
Don Gaede is an internal medicine physician.