What’s Best for the Patient?

[Note: in all of my writing, I try to place personal opinion in blue italic font to separate it from what I am reporting from other sources.]

doctor-clip-art-doctor-clip-art-4There are a number of factors that can affect decisions that doctors make about patient care. What’s “objectively best” for the patient may be only one consideration.  Patients need to know this.  While you may not be a doctor, you bear the ultimate responsibility for your own care.  You’re the one who has to live with the results.

 

Recent articles point to some of the issues that can impact treatment:

  • Doctor revenue.  Doctors can (and a few have been accused of this) maximize revenue by ordering unnecessary tests and performing unnecessary procedures.
    • A common example in the literature is the use of CT, MRI or X-ray in the first 30 days after reporting lower back pain.  Other systems besides back pain may require these test, but for lower back pain alone, no.
      • “One study found that people who got an MRI during the first month of their back pain were eight times more likely to have surgery than those who didn’t have an MRI — but they didn’t get relief any faster.” [Agnvall]
    • 61 doctors were among 301 people criminally charged earlier in 2016 with billing Medicare for care and prescriptions that weren’t medically necessary.
    • One of the current curiosities concerns rotator cuff surgery
      • Outpatient rotator cuff surgeries have increased by 272% in the last 5 years.  (Are we really that much more active??)
      • Rates of post surgery problems vary between surgery facilities from a low of 1/2% to 20%.  (If you need the work, are you having it done by the right doc?)
  • Measurements used in the current Federal “pay for performance” initiative.  “Pay for performance” is an effort to reward doctors and hospitals that delivery high quality care and penalize those that don’t.  The metrics include patient satisfaction questions, and some doctors argue that inclusion of those questions might cause doctors to cater more to what patients want than what is medically necessary.
    • That in turn raises two questions
      1. If docs pay more attention to what patients are saying, is that a bad thing?
      2. This criticism by surgeons seems similar to the complaints some teachers have about standardized testing.  In both situations, would the absence of any metrics make the situation better?
  • What insurance will cover, of course.
    • However, a dedicated physician can encourage the insurer to do the right thing.
    • My wife was injured, and the doctor felt she required a treatment the insurer was unwilling to approve.  His reaction was to hospitalize her (for which the insurer was committed to pay) until the insurer agreed to the treatment.  It worked.

What you need to do:

  • Learn how to search for information on your medical symptoms before you consult with a medical professional.  Be an informed patient.  If you don’t know, ask someone for help.
  • Prepare intelligent questions for your conversation with the doctor.
  • If tests are recommended, ask what they will accomplish.
  • If surgery is discussed, consult another doctor from a different medical practice who is unknown to the first doctor.  Conflicts of interest can be a problem, and you don’t want to go there.

Sources:

  1. Agnvall, Elizabeth, “10 Test to Avoid,” AARP Bulletin, 3 December 2015.  http://www.aarp.org/health/conditions-treatments/info-2014/choosing-wisely-medical-tests-to-avoid.html
  2. Cohen, Jessica Kim, “Outpatient rotator cuff repairs increase 272% in a decade — 5 facts on orthopedics in ASCs,” Becker’s ACS Review, 4 January 2017.  http://www.beckersasc.com/asc-turnarounds-ideas-to-improve-performance/outpatient-rotator-cuff-repairs-increase-272-in-a-decade-5-facts-on-orthopedics-in-ascs.html
  3. Frelick, Marcia, “Current Measures Flawed, Could Cause Problems, Surgeons Say,” Medscape.com, 6 January 2016.
  4. Gawande, Atul, “Overkill”, The New Yorker, 11 May 2015.  http://www.newyorker.com/magazine/2015/05/11/overkill-atul-gawande
  5. Haelle, Tara “Putting Tests to the Test: Many Medical Procedures Prove Unnecessary—and Risky,” Scientific American, 5 March 2013.  https://www.scientificamerican.com/article/medical-procedures-prove-unnecessary/
  6. Sandhu, Sarina, “40 common treatments and tests that doctors say aren’t necessary,” iNews, 24 October 2016.  https://inews.co.uk/essentials/news/health/40-treatments-doctors-saying-bring-little-benefit/
  7. Sun-Times Wire, “Skokie, Buffalo Grove doctors charged in Medicare fraud sweep,” Chicago Sun-Times, 23 June 2016.  http://chicago.suntimes.com/news/2-suburban-doctors-charged-with-medicare-fraud/
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