The Problem With Doctors

March 25th, 2010 at 5:55 am | 11 Comments |

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I keep hearing about how people are mad that government is intruding on a terra sanctum–healthcare, which should remain between a patient and their doctor, with no external intrusion (of course that’s what insurances do regularly, but that’s another conversation). The simple bottom line is that it actually hurts the system when that is left to the free market. Doctor shopping, and patient wooing, has little to do with delivery of appropriate care, but rather stylistic preferences. I’ve seen quite enough of it from the sub-specialist perch I’m on.

Simply put, there are so, so, so many lousy doctors– and not what patients call lousy doctors (e.g., poor communicators) but I mean people with bad judgment who, frankly, need someone telling them what to do more. They make bad decisions, and as a side issue, fiscally lousy decisions. Rationing, imposed standards, and increased waits, believe or not, would improve the health of our country substantially, because it would require people to think, and use evidence, and be less likely to OVER-treat, as well as being less likely to under-treat. As a side benefit, it would likely massively cut costs as well. But no one likes to talk about it, because no one wants to face the reality of just how bad medical decision making has become in the hands of the holy doctors. There aren’t nearly enough studies, but there are plenty, which show that the knowledge and judgments of a ridiculous percentage of providers is truly substandard, and the requirements for continuing medical education are a joke.

Perhaps the free market could make this happen, and I really wouldn’t care if it were the government or the free market. But there will be an intrusion one way or another, and I would hope people’s health could actually be the driver of the motives for the intrusion.

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11 Comments so far ↓

  • DFL

    My oldest son’s first pediatrician was a terrible doctor and almost killed him. Four days after he was born, during a check-up, she failed to diagnose four severe heart defects that he had- aortic stenosis, coarctation of the aorta and two holes in his heart. He went into shock the next day and almost died. Yet because she is a woman and Puerto Rican, the local Eastern Shore magazine(our version of Washingtonian) graces her picture on the front cover.

  • sinz54

    I’ve had some bad experiences with doctors too:

    Last July, a botched vascular surgery procedure on me, ruptured after I got home. The blood was spraying out under high pressure from an artery. It sprayed on the walls and on the carpet until my home looked like a scene from a horror movie. I raced to the nearest Emergency Room (a different hospital), and they managed to stop the gushing blood before I bled to death. I never did manage to clean all the bloodstains out of my carpet, and it will need to be replaced.

    But I have a straightforward fix, which may appeal to Obama’s netroots:

    Hospitals receiving ObamaCare funding should be required to maintain an online database of physician diagnoses and the results of patient followups. That information can be gathered nationally by computers at NIH and analyzed for evidence of substandard care.

    ObamaCare specifically calls out the need for outcome-based medicine. But by that, they mean the relative performance of various treatments and drugs. I would extend that to mean the relative performance of various hospitals and the individual physicians at those hospitals.

    In this case, a data mining program would correlate my visit to the Emergency Room with the surgery I had at the other hospital, and it would pop out as a potential problem with that surgeon.

    There already are precedents. There are a number of websites online where you can get patient reviews of various doctors.

  • sinz54

    One more thing.

    A study done last year, revealed that hospitals routinely alter their medical records to cover up medical errors. As many as half of all medical errors are concealed in this way.

    I have good reason to believe that the medical error I just posted about–the botched vascular surgery–was covered up. Such chicanery is easy, because that hospital still keeps patient records in giant looseleaf notebooks. It’s a snap to just remove a page describing a medical error from that looseleaf notebook and replace it with a blank page. In my case, my medical records said that I needed followup surgery but didn’t explain why. When I accused the head of the Vascular Surgery Department of covering up the error, they called out two security guards to escort me out of there.

    By insisting on online databases with proper security controls, this problem could be eliminated.

  • LFC

    sinz54 suggested… Hospitals receiving ObamaCare funding should be required to maintain an online database of physician diagnoses and the results of patient followups. That information can be gathered nationally by computers at NIH and analyzed for evidence of substandard care.

    I disagree. EVERY doctor, hospital, medical office, and health professional should be required to do this, regardless of the source of their revenues. The lack of accountability in our medical system is staggering. You have more reporting requirements if you own an auto body shop and are repairing a car that was in an accident (hence the business model for CarFax).

  • franco 2

    Notwithstanding the fact that there are incompetant medical personell and other problems, it is the height of blind faith to expect that more government interfereance will

    A cure the problems
    B Not inhibit the many good doctors from serving patients
    C Not create and enable new problems

    This is socialism and Alinsky at work folks:

    First, add a big dose of socialism to muck things up for free markets
    Second ,claim that free markets fail
    Third, bring in more socialist reforms
    Fourth ,repeat steps one through three.

  • Chekote

    A friend of mine recently has been diagnosed is a rare form of blood cancer. The doctor called him on a Sunday to let him know that blood test results had come in and that chemo had to be started immediately. Anyway, the insurance company did not approve the chemo. In the meantime, my friend did a little research on the disease and the test results just didn’t make any sense. He asked to be re-tested and guess what? The tests results that prompted calls for immediate chemo turned out to be a lab error. Last week, my friend met with a transplant doctor and he said that the chemo drug the other doctor recommended should NOT be used because it may make a bone marrow transplant impossible down the road. The moral of the story? Thank God the insurance company denied the doctor’s request.

  • Rob_654

    What these same people leave out is that the Private Health Insurance Companies already – far to often – get between a doctor and the patient by denying to pay for treatments and medications.

    Here is what is funny…

    If a Private Health Insurance Company denies you treatment what are your options? Call the 800 number and speak with someone who doesn’t care? Try to call the Executives of the company who care more about their bonuses then your health? Hire a lawyer at $350 an hour to fight? Hope to have a doctor that might call a couple of times and help beg?

    If for some reason the Government says no guess what you can call your Representative and Senators for help – and they have far more a vested interest in helping you than the Private Company does – because they want good press and they want your vote.

  • SFTor1

    I see more endorsements of a regulated health care system here every day.

    I always knew Republicans weren’t stupid.

  • budgiegirl

    I am a physician and I agree!! There are lots of mediocre doctors out there. But more importantly, doctors are not taught to consider the cost of the care they provide. Namely, they prescribe expensive drugs when there are good cheap generics. They order too many tests – out of fear of lawsuits, out of trying to “please the patient”, and out of ignorance.
    If you want to control healthcare costs, then you need to start with teaching physicians how to provide cost effective medicine. This could be done starting in med school, then residency and beyond. But what’s equally important, is you need to start educating patients – that they dont’ need every test out there, and that expensive medications are not always better than cheap medications. There is a mentality in the US that more is better – and this is not true in medicine, but it drives the practice habits of physicians and drives the costs up immensely. Nobody wants to get into the discussion of “re-educating” our physicians, because somehow that means “getting in the way of the doctor-patient relationship”. But in truth, your doctor may not really know what’s best in this regard.

  • Rob_654

    Doctors should be held accountable for outcomes. I had a throat issue and went to several ENT’s who ran all sorts of tests – repeated tests because they didn’t want to take the previous doctor’s exam results (which I found interesting that they did not trust the past exam results from other doctors) – CAT scans, etc… and they could not determine what the issue is…

    Finally I went to a public Universities medical center and they diagnosed the issue on the first visit and 6 weeks later – all is much better…

    I feel as though myself and my insurance company should have the right and the ability to go back to those previous doctor’s and simply ask for our money back. Literally thousands of dollars were flushed down the medical establishment’s rat-hole for no results.

  • budgiegirl

    @rob_654, The thing is – that diseases play out over time. What is vague at 1 week may be obvious at 1 month. Also, it makes sense to start with simple exams, progressive to simple tests to more complicated expensive tests and procedures. That is both playing the odds and providing cost-effective medicine. If every patient expected every diagnosis immediately (which is the reality of what patients want in the US), the healthcare costs go up. It’s not realistic. Also to address your comment about trusting other doctor’s exams – I would NEVER trust another doctor’s exam as gospel. I perform my own history and exam to my satisfaction. I’ll accept a copy of a test, as I am not a radiologist – but I listen to the heart and lungs myself. How could you not want that?? Plus in a court of law, I don’t think I’d have a very good defense, if I said, “Well the other doctor said his lungs were fine….” right?