We’re all aware of the emphasis on healthcare spreading through Capitol Hill. This morning, I read an interesting article by Steven Pearlstein, a business columnist with the Washington Post, dealing with what he feels is a major source of the problem – doctors. He writes that:
If we really want to fix America’s overpriced and under-performing health-care system, what really matters is changing the ways doctors practice medicine, individually and collectively.
Growing up, I thought of doctors as infallible individuals always capable of devising the most efficient route to diagnose and treat their patients; however, time has proven otherwise. It’s a bit disconcerting to know how much waste exists in the medical system. Defensive medicine (better known as “CYA” treatment) is largely responsible, but so is the general trend towards preventative measures. With all the money being poured into pharmaceutical companies and medical technology, I think there’s a growing rift in how “cost effective” doctors are. There’s a fine balance between utilizing the latest techniques versus the cost of said techniques (for the doctor, the patient, the hospital, etc.) which has yet to be obtained.
Though I strongly agree with Mr. Pearlstein, it’s difficult to propose a feasible resolution for such a widespread problem. Any thoughts?
the question is, how do we change the way doctors practice? everything has to be changed if we really want to fix the problem, which seems quite far.
Hmmm, if the way doctors practice is the problem, then perhaps we need to trace the problem all the way to the training process? Is medical school educating future doctors properly?
CYA protocol is a reaction to reality, it has nothing to do with medical school education. The reality is symptoms can point to a myriad of diagnoses, how do you rule them out? By doing tests. Tests cost money. However, it’s a lot cheaper than a big settlement from a malpractice lawsuit. We can thank people like John Edwards, who built his career off of suing doctors and hospitals, suing OB-Gyns saying they caused cerebral palsy, which was based off junk science. We now know from studies it’s usually idiopathic.
You and I truly think similarly, you are write my mind.
In my opinion, CYA appears to put the doctor first and the patient second. It is doctors who are afraid to get sued and use defensive medicine as a shield; it is this fear of messing up that puts the patient second. Is the physician running the tests to cover his own ass or for the good of the patient? You can say “both”, but people can’t fool me. Americans love to sue and hence, CYA protocol was developed. Other developed countries do not have this problem, at least not in such a large scale. If we could stop Americans from suing the fact that we aren’t perfect, it would be a start.
I sometimes also doubt if med schools are educating doctors properly. Some come out of med school all freaked out about CYA and the fear of malpractice that they lose focus, lose innovation and vision, they just become average and typical physicians that make you wait forever in the lobby.
Though many will argue patient autonomy will never change and med school education probably will never change, history has shown that things do change. Back in the day, rednecks all over the nation argued that a black person will NEVER become President of the United States. Guess what? That changed. So can healthcare and medical education in the USA.
And I don’t intend to practice medicine here. America is a nation of sick care, not healthcare. That’s my $0.02.
In America, people come to do the doctor when they are sick, not when they are healthy. The American healthcare system has become one in which people come for secondary prevention, not primary prevention (to stop from getting the disease in the first place). And then you have idiots like this: http://mediamatters.org/mmtv/200906120033
Yes, bc Americans LOVE to sue, what ends up happening is a doctor ends up getting a CT scan for a headache to rule out a head bleed. The suing rate is much lower in other countries, but they also have a lot less technology available or at least not in a timely fashion, so that is why doctors there are so heavily adept at physical examination in detection, vs. here even if we catch things by physical exam what do we do? We order a test. Example: You hear an unusual heart murmur on physical exam, but you end up ordering a 2D echo.
Also with respect to your point about doctors having patients wait for long times in the lobby. That has nothing to do with physicians being average or typical. Each patient sometimes has a lot of concerns to bring up and the doctor needs a much longer time with the patient. Now if EVERYONE does that, then it makes each appt. even longer and stretches it out. If anything the doctor cares more, as most doctors will cut you off, as they consider the pt. to be “blabbering”.
Medical school education always changes, bc medical knowledge changes all the time. That’s nothing new. As far as patient autonomy changing – don’t hold your breath. You can not compare that to Jim Crow laws bc it’s a completely different issue. Patient autonomy PROTECTS the patient (whether you agree with it or not), unlike Jim Crow laws which hurt citizens and were found to be unconstitutional.
Just on a side note as far as rednecks not wanting a black person to be president it definitely wasn’t due to a lack of trying on their part whether it was calling him the n-word, “a Muslim”, a “commie fascist” (which makes no sense as communism is extreme left, fascism is extreme right), a “halfrican”, “a terrorist”, “an Arab”, etc.
…don’t forget a “community organizer.” 😉
Some great points by both of you! One of my next posts deals with a specific aspect of medical school education – problem based learning. Stay tuned for that.
And thank you so much for that Limbaugh video. Made my day, ahaha! 😀 Though I’m conservative, Limbaugh’s ability to step beyond the bounds of common sense never seizes to humor me.
LOL. I know!!! I couldn’t believe it myself at the RNC – when I watched and I said are they freakin’ serious? They are seriously, on NATIONAL television, putting down community service (only one part of his CV but I digress).
So let me get this straight – you don’t want to use taxpayer dollars for an issue (which is perfectly fine and ok), but then when people have the enthusiasm to band together to do something without using ANY taxpayer funding and are privately funded – example: Habitat for Humanity, they are putting THAT down too??? How messed up is that? Funny part is the next day, John McCain (who didn’t even make those comments) had to go with his tail between his legs to explain his supporters idiocy on guess what? A televised forum on the importance of community service.
Yeah, I usually get what Limbaugh is driving at, but this was a pure detachment from reality. Yeah, Rush, that’s what we’re seeing all the time athletic people with injuries (gauze and tape must be expensive where he lives) not those morbidly obese patients with a long list of medical problems due to obesity and sedentary lifestyle who come in for ruling out of heart attack. Geez.