David Ring is an internationally renowned orthopaedic surgeon at one of the top hospitals in the U.S.. He's tall, handsome and, for the most part, silent -- except when he starts talking about his work, which is when he really comes alive. He loves what he does. But he doesn't love the role that money plays in medicine.
"Doctors who own stakes in testing labs order more tests. I've experienced that first hand. The minute you see dollar signs in your patient's eyes, it changes how you think."
Ring isn't happy about the way medicine works but he is prepared to be blunt about it.
"I'm an academician and devoted to things that don't earn money but I watch people come into the profession on my path and gradually get off of it. First they just want to be good surgeons. After a few years, they start to realize that what they do determines how much money they make and they start to learn a new game. The old game was: diagnose well, communicate well, do the surgery well. The new game becomes: make money. They don't really see the game change, they're blind to it."
Ring's direct personal experience validates a battery of academic experiments recently that have shown that money can have an anaesthetic effect. When students submerged their hands in very hot water, the pain reduced faster if they got to count money afterwards.
Money can make you hang from horizontal bars longer and it can mitigate the pain of social exclusion. We may think we are immune to the persuasive powers of money but we're wrong. And nowhere is this more expensive than in its impact on American medicine.
Arthroscopy for arthritis, says Ring. That's a classic example. You definitely don't cure osteoarthritis with arthroscopy. There was one brave guy in a VA hospital in Texas who did a pilot study comparing knee arthroscopy with washing the knee and cleaning the knee out. All three treatments were equally effective! But there's a lot of money in arthroscopy. The response of American surgeons was very defensive. It is a willful blindness: you bypass curiosity and scientific knowledge and concern for your patient and go straight for the profit motive.
Ring sees that money blinds us to what is good for patients, what is good for healthcare. But it is a kind of willful blindness too to imagine that this isn't true. We may wish our physicians to be saints. But we need to understand that they're human.
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So it would be simple for good orthopedic doctors along with consumer groups and AARP to force Medicare and Insurance companies to stop paying for arthroscopies for arthrits.
Payment will only be made afer an automatic audit of the procedure. We complain about waste and then we reimburse waste ... big time.
Same principle can apply to a host of unnecessary procedures. How difficult can that be?
very different thing.