This is yet another aspect of the end of life issues we have been discussing. Necessity and quality of care are challenges we all confront. It would beinteresting to hear from the physicians in our group what they think.
Nasik Elahi
It was lunchtime before my afternoon surgery clinic, which meant that I was at my desk, eating a ham-and-cheese sandwich and clicking through medical articles. Among those which caught my eye: a British case report on the first 3-D-printed hip implanted in a human being, a Canadian analysis of the rising volume of emergency-room visits by children who have ingested magnets, and a Colorado study finding that the percentage of fatal motor-vehicle accidents involving marijuana had doubled since its commercial distribution became legal. The one that got me thinking, however, was a study of more than a million Medicare patients. It suggested that a huge proportion had received care that was simply a waste.
For the rest of the article please click on the link.
http://www.newyorker.com/magazine/2015/05/11/overkill-atul-gawande?mbid=nl_050515_Daily&CNDID=17878219&mbid=nl_050515_Daily&CNDID=17878219&spMailingID=7717036&spUserID=MjQ4NTYwMzU4NDkS1&spJobID=680489128&spReportId=NjgwNDg5MTI4S0
Related
This article is written by the same author that wrote the book I recently reviewed on the TF. And in a long winded article, with an over abundance of examples. he brings another of the issues that plagues the medical profession to light.
He describes multiple reasons why people get unnecessary care like doctors’ ignorance as to what is necessary and what is not; doctors trying to practice “defensive” medicine and finally the issue of doctors enriching themselves. The first two, even though troublesome do not bother me as much as the last one, especially if that care may end up harming the patient. That essentially is a crime not malpractice. I can quote my own example. I had sent my niece to an ENT I knew for her complaint of Tinnitus. The doctor advised her some surgery. My niece asked me to talk to him, which I did when I met him in the hospital parking lot and his response was “oh I am a surgeon and surgeons like to do surgery; she can wait and watch”. He never got a referral again from me.
But it is the way our medical system is set up that leads to such fraudulent practices. I compare the interaction between a patient who has insurance and a doctor to the following. An unknown person sends you his credit card and tells you to buy whatever you want, no questions asked and he’ll pay the bill. Would you buy only what you NEED or would you go all out and buy what you WANT? Most likely the latter. You have no incentive to be careful with the cardholder’s money since you don’t know him and he doesn’t know you. In the doctor-patient encounter neither has the incentive to be careful with what is spent; patient is happy to get the most care(even though it may be detrimental to his health) and doctor doesn’t mind doing unnecessary procedures to enrich himself/herself. Neither patient nor doctor knows the bill payer(the insurance company, who mostly pays out whatever is charged; they can always increase premiums if their expenses go up). Now I am not saying all doctors indulge in fraudulent practices but sadly a significant percentage do and some even boast about it when you meet them.
So as long as both the parties involved in patient care have no incentive in keeping an eye on the cost we’ll never be able to control costs. The other alternative is to have a British or Canadian system where doctors have no such incentive. That system has its own issues including delayed care; some people think taking away financial incentive may lead to doctors providing poor care. Every system comes with its good and bad. We’ll have to decide which system has more good than bad.
Shoeb