New NYT editorial bashing doctors

[womp]

Doctors and the Cost of Care (6/14/2009):
http://www.nytimes.com/2009/06/14/opinion/14sun1.html?_r=1

"There is disturbing evidence that many do a lot more than is medically useful — and often reap financial benefits from over-treating their patients"

"If the government is going to help subsidize coverage for the millions of uninsured, it will need to find significant savings in Medicare spending, at least some of which should come from reducing over-treatment. In the long run, if doctors can't be induced to rein themselves in, there is little hope of lasting reform."

"Doctors have been complicit in driving up health care costs. They need to become part of the solution."

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[MOHS_01]

Doctors and the Cost of Care (6/14/2009):
http://www.nytimes.com/2009/06/14/opinion/14sun1.html?_r=1

"There is disturbing evidence that many do a lot more than is medically useful — and often reap financial benefits from over-treating their patients"

"If the government is going to help subsidize coverage for the millions of uninsured, it will need to find significant savings in Medicare spending, at least some of which should come from reducing over-treatment. In the long run, if doctors can’t be induced to rein themselves in, there is little hope of lasting reform."

"Doctors have been complicit in driving up health care costs. They need to become part of the solution."

Did not read the article (the Times just irritate me, so I avoid it at all costs), but I am inclined to believe that this is largely true to a great degree. I have said it many times before -- economics influences decisions. If we want meaningful change, a couple of things have to happen:

1. as a profession, we must determine what works at what (marginal) costs and in what populations

2. reimbursement mechanisms must reflect this.

 

[Miami_med]

This sort of argument is somewhat akin to blaming servers for the rising costs of eating out because they are pushing more expensive drinks from the bar. The underlying problem is that the patient is usually so many degrees seperated from the costs of treatment, that they virtually always want the most expensive treatment. We all agree that the current system of reimbursement is a mess. Overtreatment is a really funny term when used as a blanked statement in this case. To assume that most overtreatment is about physicians' bottom line is extraordinarily simple in its analysis. The incentives in the current system are all quite perverse, but many more of them are for protection against financial loss than real financial gain (in the sense of taking a CYA approach regarding litigation and what not). There is also the category into which about 99% of disputed treatment would fall in which there is potential or margnial benefit, but it's not obviously worth the cost.

 

[Instatewaiter]

Did not read the article (the Times just irritate me, so I avoid it at all costs), but I am inclined to believe that this is largely true to a great degree. I have said it many times before -- economics influences decisions. If we want meaningful change, a couple of things have to happen:

1. as a profession, we must determine what works at what (marginal) costs and in what populations

2. reimbursement mechanisms must reflect this.

While I have seen first hand pt being sent for worthless tests that are very expensive (polysomnogram for someone without a clear indication) I can see where this may lead. Just more bureaucracy.

Personally I don't want to have to have my medical decisions okay'ed by some pencil pusher who is not a doctor just to ensure I am not ordering needless tests.

 

[MOHS_01]

I understand what you are saying, but we cannot have it both ways. You cannot ask the government, private insurers, or citizens to foot the bill without giving them some say in determining what they will pay for and what they will not. Specialty societies should determine what works and what does not, and the relative degree of advantage between modalities, etc. Payors can then determine whether the marginal utility is worth the economic costs. Competition can be had between insurers (not once gov't gets involved, however) on the relative pricing mechanisms for what constitutes a covered service. This will be detrimental to specialty care often times, for the marginal utility of certain services will be shown to be not worth the economic costs. Every service can still be available in this system somewhere; the moral hazard involved centers on the fact that providers will take the brunt of the hit here, and expensive but effective modalities will become concentrated in population centers... furthering the already existent disparities in rural and urban care.

 

[Paddington]

Well they're definitely right to an extent.

What I've noticed and been frustrated by is that each attending likes to blow a lot of hot wind about how all those other doctors out there are stupid and keep ordering lots of unnecessary tests. But each one of these doctors does the same thing themselves.

 

[edmadison]

Truth be told, there are a lot of docs taking advantage of the system; don't get me started about CT Angiograms.

Ed

 

[MOHS_01]

Just an observation, but whenever someone starts harping on "the abuses of the system", they more often than not use a cardiology scenario....

 

[LADoc00]

NYTimes is the most ragingly left wing neo-socialist newspaper with an, albiet dying/dwindling, audience.

Read the WSJ. BY FAR the best periodical out there. Docs in NYC need to start refusing to treat ALL employees of the NYT.

 

[tibor75]

NYTimes is the most ragingly left wing neo-socialist newspaper with an, albiet dying/dwindling, audience.

Read the WSJ. BY FAR the best periodical out there. Docs in NYC need to start refusing to treat ALL employees of the NYT.

WSJ? The same periodical that champions the greatness of no oversight in the financial markets? Gee, how did that work out?

 

[RGMSU]

What is happening to doctors is the same thing that happened to airline pilots over the last 30 years. Airline pilots were damn near Greek gods in the 1970s - watch Airport sometime if you need to see what I'm talking about - then the public began to respect them as a profession less and less. Now, most people view them as "bus-drivers in the sky," until of course the plane starts to nose dive, then they're a freaking savior if folks make it out alive. Same thing with doctors. Doctors used to be hot stuff. Now, everybody wants to knock doctors off the hill. Nurses, PAs, NPs, pharmacists, etc are all hostile toward doctors on a regular basis. They are not content with their position. They wish they were a doctor instead. So, they bash the thing that they, for whatever reason, could not muster up to be. No offense to these ancillary medical personnel. I just have seen this to be true in medical environments I have been a part of thus far. Patients now think they are "entitled" to a doctor's time and expertise, so physicians are just like talking to the dude behind the post office counter for those folks. Of course, when somebody really needs a doctor, whether it be the nurse who can't figure out what the hell to do next or the patient who's crashing on the table, then suddenly doctors are alright again. Until the bill shows up in the mail or the crisis is over - then back to business as usual. You'd think doctors would get something for the 12 years plus of education, the massive debt, and all the 2 AM phone calls they respond to. Instead, they usually just get a bunch of sass and bull.

 

[McDoctor]

Just an observation, but whenever someone starts harping on "the abuses of the system", they more often than not use a cardiology scenario....

I agree, and by far pulmonologists and their newfound pre-occupation with sleep studies and sleep labs and sleep medicine in general is probably the most egregious example of overutilization I can think of and see on a day to day basis.

No matter why I refer a patient to pulm, be it lung mass or chronic cough or uncontrolled asthma, they always, and I mean always, get a sleep study.

 

[RGMSU]

WSJ? The same periodical that champions the greatness of no oversight in the financial markets? Gee, how did that work out?

Too much oversight is just as bad as too little. We need to learn to find middle of the road instead of extremes. In everything, balance. Same thing with the healthcare system, get people insured but don't go absolutely crazy imposing a bunch of restrictions on care and cook-book recipes for diagnoses and treatments. Maintain both private and public options, but for heaven's sake learn how to fund the public options effectively instead of creating another Medicare-like debacle on funding. Everybody doesn't have to have the same healthcare. All doctors don't have to do everything the same way and make the same amount of money. We should all fight to maintain choices - for patients, doctors, and everybody else. We're not all robots.