Fear and greed are potent motivators. When both of these forces push in the same direction, virtually no human being can resist. And doctors -- despite many expectations to the contrary -- are human beings.
This is one reason why medical costs in the U.S. have spiraled out of control, yet we are among the least healthy people in the developed world.
On the fear side, consider this email I got from a physician friend who had read galleys of my book Why Our Health Matters: A Vision of Medicine That Can Transform Our Future which will be released September 8, 2009:
"You should spend some time with me in our ER, which is totally typical of what is going on all over the U.S. Incredibly expensive, unnecessary, and potentially harmful X-ray scans are ordered with gay abandon on all patients to make sure that 'nothing is missed' that a lawyer might later use against the ER. Patients with the most ridiculous complaints are admitted to the CCU [critical care unit] just to make sure that an MI [myocardial infarction, a.k.a. heart attack] is not missed. I would guess that $10,000 dollars per day or more of wasted X-ray radiation studies occur in our ER everyday. Multiply this times 365 and times the thousands of ERs in the country and you come up with billions and billions of dollars of pure waste in our system."
Physicians like to discuss the fear side, because it shifts the blame to lawyers. The greed side, however, deserves just as much scrutiny and reform. Consider "The Cost Conundrum: What a Texas town can teach us about health care," a must-read New Yorker article by Atul Gawande, M.D. Gawande visited McAllen, Texas, to discover why per-capita health care expenditures there are the highest in the nation. He found that many physicians in high-medical-cost cities such as McAllen have a diversified "revenue stream," the result of what one hospital administrator termed "entrepreneurial spirit." This "spirit" often manifested in physicians owning their own medical testing equipment, which meant the more tests they ordered, the more money they made. A 2002 University of North Carolina study showed doctors who own imaging equipment sent patients for roughly two to eight times more imaging tests than those who don't own.
In Gawande's article, a McAllen doctor who refused to hop aboard this gravy train had a more sensible take on the local "spirit." "Medicine has become a pig trough here," he said. "We took a wrong turn when doctors stopped being doctors and became businessmen."
Lest you think the only drawback of over-scanning is wasted billions, note that from 1980 to 2006, per-capita radiation dosage from medical testing more than quintupled. A controversial study published in the November 29, 2007, New England Journal of Medicine estimated that computed tomography (CT) scans -- the type of imaging that has grown most explosively -- administered today could eventually cause up to 2% of cancer deaths.
As with fear, greed also propels expensive, inappropriate treatment. If a clinic loses money each time it counsels a patient to control type 2 diabetes with diet and exercise, but makes a hefty profit when it amputates a foot riddled with diabetic ulcers, how long will it continue to emphasize the former?
Because these problems have two causes, the solution is twofold.
To quell the fear that drives physicians to over-test and over-treat, we need vigorous legal reform to cap malpractice payouts. Staunching the greed motive requires a more dramatic change. Since a single CT scanner can bring in $400,000 a year in profit, it's vital to sever the link between ordering tests and making money. Restricting ownership of testing equipment to nonprofit, government, or independent private entities is crucial.
As for popularizing less lucrative -- but often better -- low-tech treatments, putting physicians on salary can also help. Whether the paycheck comes from a nonprofit organization such as the Mayo Clinic or some variety of single-payer national health care, stabilized incomes would let physicians more readily focus on the health of their patients rather than on their own finances.
Until both of these corrective measures are in place nationwide, it's up to you to ask your physician if the tests or treatments ordered for you are truly essential. You might get an honest answer about the test's potential risks and benefits. Then, together, you can arrive at a decision that satisfies both of you.
Andrew Weil, M.D., is the founder and director of the Arizona Center for Integrative Medicine and the editorial director of www.DrWeil.com. Become a fan on Facebook.
Follow Dr. Andrew Weil on Twitter: www.twitter.com/DrWeil
My advice: take things into your own hands and follow your instincts! Believe me, those doctors are NOT looking out for your best interests.... nor health. Just $$$.
But add an OPT OUT for those wanting to buy commercial health care Insurance and suddenly you have the Strongest possible Public Option!
People could solve their health care problems simply and effectively!
With from 100,000,000 to 306,000,000 people in Medicare for ALL "FAIR PRICES" can be negotiated with all aspects of health care.
This does away with the 1,000+ pages of loopholes and "duct tape" applied to the existing systemS!
Hr 676 is a simple to read and understand 50 pages - make that 51 when you add the OPT OUT clause! Be sure to add in preventative care requirements so 56 pages!
If you correlate by ethnicity, Americans are actually among the most healthy in the world. For example, the average lifespan among white non-hispanic Americans compares favorably to that of white people in any other western country. It's within a few months of the average Japanese lifespan -- the highest in the world. Likewise the lifespan among Asian Americans. The lifespan of Americans who immigrated from Africa or Jamaica within the last two or three generations compares favorably with the lifespan of similarly recent Jamaican and African immigrants to England.
Our overall average is lowered significantly by the lower average life-span among African Americans, but there is no proof that the average lifespan of African Americans would be any higher were they living elsewhere. (Much of the lower average lifespan is due to murder and use of illegal narcotics, which has little to do with the funding of medical care.)
So basically, critics of our health statistics are merely bemoaning America's greater racial diversity. Nationalizing health care isn't going to change that.
I agree, expanding Stark is probably a good thing. However, do you really want your MD salaried? If you are on salary, there is little motivation to work or provide quality service. Most MD's work 60-80 weeks. What happens to health care when that drops to 40? Who will see the patients? Who will answer calls after the shift is up? So what if you leave the practice, the doc gets paid either way. In fact, he/she would have to work less if more people leave for another doc. We already have a doctor shortage and a high burn-out rate and its only going to get worse. Much worse.
People on Medicare / Medicaid do not get the same care as someone with plenty of money to pay for good health care .
This is why we do need a single payer system in this country and to repair the Medicare and Medicaid system . Is it really moral that only those who are wealthy receive good health care in the US ? I really don't think so .
Maybe the reason why patients demand tests is because they don't feel their doctors are listening to them . So that leaves the patient to fear a serious problem could be over looked because of the doctors need to quickly diagnose him / her and get you out the door .
The whole system is broken ! Doctors need to go back to their roots and take more time with patients instead of watching the clock .
How many times I have gone to a doctor and found he had over booked and the wait was an hour or more because two of us had the same appointment time scheduled .This is more common than not !
Also a lot of these doctors who do over book belong to a health group corporation with other doctors and the agency sets down rules as to how many patients are seen in an hour etc. These agencies are interested in one thing and that is profit ! Profit is more
There is a group of physicians called Mad As Hell doctors that are currently criss crossing the country and advocating Single Payer System to reduce billing fraud and waste and improve health care. President Obama has turned them down so far in their request to meet with him and discuss the Single Payer Option.
http://MadAsHellDoctors.com for more info.
Nonethelss, there wil be an up/down vote this Fall on H.R. 676 as promised by Nancy Pelosi according to: http://www.singlepayeraction.org/blog/?p=1431
Ralph Nader reports from Harvard Professor Henry Sparrow that north of $100 Billion per year is currently being wasted in billing fraud and schemes in our Capitalistic system-sometimes from doctors who've been deceased for years-driving up costs of health premiums significantly and rationing care.
http://nader.org/index.php?/archives/2137-The-Drive-for-Single-Payer.html
FactCheck.org reports that of the 48 claims in the house bill about healthcare at least 26 of them are false and many more are misleading coureousy of Republicans and Blue Dogs.
I don't think its fair to say that the problem is the doctors greed or the fear. I've very occasionally felt like a doctor ordered a test to make money for himself and never because he thought I would sue him. I suppose I don't have the personality. I've had a lot of tests I knew were probably unnecessary, but the doctor just didn't have time to think through my case.
We need more doctors and they need to be paid for outcomes rather tests and short appointments. The system is the problem.
"x-rays and antibiotics"
People get pissed when they don't get what they came for and God forbid that you should correct their personal diagnosis.
There is no easy answer to overtesting. It is not possible for the patient to make decisions when in the midst of pain or an emergency situation. While it is the doctor's responsibility to discuss risks and benefits of all medications, procedures and treatments, almost no doctors do this anymore. That is because the patient is not the client: the HMO is the client. If the HMO says "go right ahead, we'll pay for it," that's what the doctor is going to do.
Think about this: When did colonoscopies become "routine?" They became routine when insurance companies started covering them. Before that time, they were only done (as they are in Europe today) if symptoms warranted the risks. Today, in the US, most patients are led to believe colonoscopies are essential and everyone should have them. This is one example of how we have stopped being patients and started being the vehicles for doctors to get money from the HMOs.
Do doctors discuss with patients. I should imagine so, they will discuss as much as they can in the fifteen minutes an HMO designates for them to spend on the patient.
One of the basic laws of economics is that supply creates demand; only the price is variable. So, having the equipment will cause the use of the equipment even if that use causes 2% of the cancers.
Finally, 65% points out that the patients aren't medicine's customers, the insurance companies and HMOs are the paying customers and always right -- even when they are totally wrong.
Dr Weil, a great man widely admired, seems to recommend the English system where the National Health Care doctors are employees of the state. In the United States this would be the pattern of the Veteran's Administration. The Obama administration is significantly increasing the funding of the VA and liberalizing access. The VA could become a Trojan horse for an incremental increase of health care provisioning: liberalized first to cover all veteran's complaints, then extended to family members.
So, we observe these matters of life and death, offended that he might be so cool. In the meanwhile, he assures that SOMETHING will be done and alternate avenues of approach are opened up.
Yet, there are points. The major point is that it makes the patient the medical industry's customer again rather than the insurer. Such programs can be improved by guaranteeing essential coverage and with a pass for an annual checkup.
The essential coverage can be covered with a credit program and by obliging the industry to cover the cost of its mistakes. That is to say, even the tort reform -- so cynically promoted by people who want to abandon the sick -- can be incorporated in a grand plan with arbitration and concern for lost income. This means "pre existing conditions" would shift to under the catastrophic insurance to be fully treated from their first discovery or be irrelevant as pre existing.
It often seems that medical care in the United States is not just expensive but irrational. This may be a matter of being hyper sensitive and sweating the small stuff.
That good doctors might make lousy business people is logical, but shouldn't matter. People with business management training abound seeking jobs and can carry the doctor, enlarging the practice with staff, nurses and paramedics -- and lawyers on retainer if that is necessary.
http://videocafe.crooksandliars.com/heather/real-time-bill-moyers-health-care-human-ri
folks who are NOT RICH.
And that means that someone is going to get a tremendous pay cut...sorry but when a CEO makes thousands of times more than his lowest paid worker something is seriously out of whack
Lastly, like that "Twisted Sister" tune...
"We aren't going to take it anymore"
Either we bring back the jobs that have been outsourced AND we make healthcare affordable..
OR...
There's going to be hell to pay for it!
The results of the study revealed a fracture of C-2 involving the posterior arch. The child was immobilized and referred for a CT scan for further evaluation.
I was very glad I ordered that x-ray on this child.
I have had several incidences where I felt the X ray was going to be negative but they turned out to be significant.
Take from this example what you want but I have never forgotten the lesson I learned from this seemingly healthy 3 year old child.
BTW, I also refused the surgery that two doctors recommeded. Today, my back is fine.
Medicare works doesn't it? What about Social Security?