Please elaborate. Are there specific instances you have observed where a physician over-treated a patient for personal financial gain?
I can give you anecdotal evidence. A professor of mine in undergrad told us about how he hurt his arm in a farm accident. He went to a hospital which paid it's doctors in a fee for service manner and the orthopedic surgeon tried to schedule a surgery right away. A bit turned off by the way that surgeon acted, he went to get a second opinion at a nearby university hospital in which doctors are salaried. The orthopedic surgeon there told him he could get the surgery, but that he would invariably recover as well by just resting it. His arm is more/less fine now, without the surgery.
This doesn't exactly fit what I'm saying, but I view this as an abuse: at my mother and grandmother's office, there is a TV in the small waiting room which blasts (loudly because many of her patients are elderly) an infomercial, in loop, for a cosmetic fat removal procedure she does.
One of my GF's good friends is an attending pediatrician at a top 10 university where all doctors are salaried, and she's observed differences in the way her fellow docs treat vs. those at another excellent hospital in which doctors are paid in a fee for service manner. One pediatrician she knows for instance performs tonsillectomies whenever possible, and strongly encourages his patients to have them. Obviously this is hearsay, but she was saying that may of the procedures this doctor performs are unnecessary, however because the reimbursements are so generous, he tries to do as many as possible.
Another story I heard of was about a colleague of my girlfriend's ex, a gastroenterologist, who basically mastered a single procedure (not sure what it was, maybe colonoscopy), because even though he was salaried, if he hit his quota for this procedure, he would get very sizable bonuses for each subsequent procedure. Accoording to her he avoids seeing patients unless he can do said procedure.
The radio show This American Life also had a great segment on the looming health crisis, and in discussing over treatment, they mentioned the preferential use of a certain new metal device for spinal surgery, over the use of the former standard, which used parts from a pig (I don't remember the exact procedure). This metal device cost far more, and reimbursed better, and unsurprisingly, even though it did not show any greater efficacy, it was preferentially used by surgeons. It also discussed research that showed that putting more doctors in a given area didn't force down costs because of increased competition, but rather doctors found ways to get more services out of the fewer patients they had to maintain their profits.
There's more, but you get the point.
In all honesty, this shouldn't be a shock. I would imagine most doctors wouldn't look at their patients as meat-bags full of cash, however there are some who do, and there are many others who might be very tempted to perform a procedure that while not necessary, might help a patient, and will also reimburse quite well. The fee for service system is set up for abuse, not only because of the massive conflict of interest, but because of the strong trust between the doctor patient relationship. It is very easy, when it comes to personal health, and more so for the health of loved ones, to get people to agree to anything.
I don't understand what the problem is here.
Cardiac auscultation is an inexact, highly observer-dependent science. There's no dearth of studies out there that have shown that even experienced cardiologists (who have been extensively taught how to "distinguish murmurs and diagnose with the scope") have difficulty picking up mild-moderate pathology on auscultation alone. If there's appropriate clinical suspicion, then what's wrong with sending a patient for a safe, non-invasive, highly accurate diagnostic test?
Perhaps it wasn't the best example, but what I was getting at is the use of expensive diagnostic tests in a situation where a well trained and versed physician could rule out pathologies without their use. This reliance on good, but expensive, diagnostic tests make for physicians who are less able to avoid using them. I'm sure for instance that a doctor who is skilled in auscultation will be more able to distinguish innocent murmurs and avoid sending a patient to get an echo.
I also don't mean to imply that the problem is only from the physician end. It's a systemic problem, with patients being equally responsible for the massive problems there are in healthcare.
