It’s well recognized that health care costs more in the United States than anywhere else in the world. There are myriad of complex reasons, but one aspect of health care costs that often gets lost in the conversation is how much Americans are paying for services they don’t need. Overuse of antibiotics is an often go-to example of this, but it happens with screening tests as well, especially when guidelines aren’t clear or are frequently evolving.
A recent study in JAMA Internal Medicine highlighted an excellent example of patients receiving interventions they don’t need, cost money and can cause harm. Studies like these are worth reporting on their own, but also can inspire larger stories that go deeper or look more broadly at a particular field, geographic region or population of patients. (Disclosure: I reported on this particular study for a news publication.) Continue reading
Doctors are in such a position legally, economically and socially that it is difficult to fight patients’ demands for excessive, well-advertised tests and treatments, Dr. Scott Haig writes in Newsweek. This insatiable, ill-informed demand is a key reason why the consumer, too, is a guilty party when it comes to soaring health care costs.
Haig writes about how, despite the fact that their condition could be easily and accurately diagnosed with no technology at all, two of his patients demanded MRIs for their ruptured Achilles tendons. Their insurance would cover the procedure, and one of them had even seen an advertisement trumpeting the hospital’s fancy new MRI machine. Convincing a pushy patient that the fanciest, most expensive treatment or diagnostic technique isn’t the best one is an often insurmountable challenge, Haig writes, a challenge that becomes ever more significant as pressure to cut health care costs mounts.
Blocking a patient who wants something they saw in an advertisement is time-consuming. Teaching the complex truth one on one is a lot harder than convincing large numbers through eye-catching, sound-biting market psychology. It’s a money loser too. Most of the time, a patient who has been sold on something you don’t want to use will just leave and go to another doctor.
We face this issue every day: the pill they saw on TV or in the magazine, the new scan, the diet supplement, even the specific brand of hip or knee prosthesis are difficult, occasionally impossible, to deny to the folks who ask for them. In the American doctors’ precarious medico-legal (and fiscal-social) position, career success is increasingly built on cooperation with the corporate and government powers that touch us. Playing along with that sketchy (but expensive) new treatment or being a champion of the wacky new state initiative is more likely to help your career than giving an educated but honest appraisal of actual patients’ well being.