Health costs need to be addressed by doctors, patients, and lawyers

It’s no secret that our health system encourages doctors to order too many tests.  Compounded with the widespread belief that more tests equates to better medicine, the reasons why health costs are spiraling out of control aren’t a secret.

In a perspective piece from the New England Journal of Medicine, physician Sean Palfrey notes our dire situation:

Recent advances in scientific knowledge and technology have resulted in the development of a vast array of new tests, new pharmacologic agents, and new diagnostic and therapeutic procedures. These are so accessible to us in the United States that few of us can resist using them at every opportunity. By being impatient, by mistrusting our hard-earned clinical skills and knowledge, and by giving in to the pressures and opportunities to test too much and treat too aggressively, we are bankrupting our health care system.

To fix this, every player in the health care arena needs to take responsibility, and make changes. That means doctors, patients and lawyers.

For doctors, Dr. Palfrey urges that, “we as clinicians must change our practice patterns, but first the medical community, through standard-of-practice guidelines, must give us permission (or better yet, encourage us) to practice in a less costly way, so we don’t feel we are expected and incentivized to order expensive tests or treatments.”

For patients, “we need to teach our patients that more medicine is not better medicine, that it is poor health care for doctors to order too many tests or too many interventions, and that costly efforts do not equal better health care.”

And, finally, for lawyers, “the legal system needs to be more restrained about pursuing lawsuits when a difficult diagnosis is missed or a treatment fails, to diminish the pressure on health care providers to practice expensive, defensive medicine at every turn.”

There will be, of course, opposition from each constituent. There are physicians, for instance, who oppose practicing by guidelines, calling it “cookbook medicine.” Some patients will always ask for the best, most expensive test or treatment, and put their own individual health status above that of the general public. And there will always be lawyers who dispute the assertion that medical malpractice litigation is a contributor for health costs.

Until each party takes responsibility and propose solutions that may not be in their selfish interest, but instead, benefits the our health system as a whole, it’s unlikely that we can change the trajectory of our soaring health costs.

 is an internal medicine physician and on the Board of Contributors at USA Today.  He is founder and editor of, also on FacebookTwitterGoogle+, and LinkedIn.

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