TW: This was the intriguing follow-up to the piece in which the author advocated the implementation of more regimented treatment protocols. Begley attributed much of the opposition to doctors seeking to protect their turf. Many doctors responded blaming patients who irrationally demand Cadillac treatment where the Chevy would suffice.
This dilemma frames the massive challenges associated with health care reform. Yes your health care spending is someone else's revenue, a problem for sure. But if YOU are not directly paying for a good YOU will tend to demand more of it especially if it relates to a good such as your health or even more pressing probably a loved one's.
From Begley at Newsweek:
"...Doctors may be paragons when it comes to using only treatments that have been proved to work. Patients are a whole ‘nother story.
...I mentioned the 2004 study finding that something like 10 million women who had had total hysterectomies for a condition other than cancer were still getting regular Pap tests even though they did not have a cervix. Dr. Kaplan went me one better. After medical groups concluded that women who have had several clear Pap tests in a row (and met a few other criteria) can get the test every three years rather than annually, a California clinic began to implement that recommendation. But when it told its low-income patients that they could skip the Pap test this year, the women rose up in protest. How come those rich women going to private doctors get an annual Pap test, and you’re letting me have one only every third year?, they demanded.
...some of the points the unhappy doctors...What are they supposed to do when a patient demands antibiotics for a cold? for a child’s ear infection? when a patient demands an MRI for back pain or knee pain? If they refuse, several doctors told me, they can expect a call from the patient’s lawyer that afternoon.
...as long as patients demand the most expensive, newest, high-tech pill, scan or treatment, we’ll never implement good medical practices. Doctors just can’t be expected to stand up to this onslaught themselves. Which is why evidence-based medicine needs to have teeth in it, and those teeth have to do with insurance coverage. Simply put, if Medicare and private insurers refuse to pay for things that are not needed or that do not work, then patients will stop demanding them and doctors can stop acquiescing in this insanity. Just to be clear, this is about more than saving money. It is also about giving patients the best treatment: prescribing something that doesn't work exposes a patient to side effects with no attendant benefit.
The American Medical Association issued a statement on Feb. 20 supporting comparative-effectiveness research but, curiously, insisted that whichever government entity conducts or disseminates that research “not have a role in making or recommending coverage or payment decisions. . . . Physician discretion in the treatment of individual patients remains central to the practice of medicine.” In other words, it’s fine to disseminate research showing that antibiotics for colds are a waste of money and an excellent way to spread antibiotic resistance, but for God’s sake don’t let insurers refuse to pay for the prescription...."
http://blog.newsweek.com/blogs/labnotes/archive/2009/03/03/antibiotics-for-colds-and-other-tales-from-the-trenches.aspx
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