U.S. Healthcare: When Is Enough Enough?
A new survey in the journal Health Affairs synthesizes nearly everything I believe is wrong with the U.S. healthcare system. The survey found that patients believe that more care is better, that the latest and most expensive treatments are the best, that none of their doctors provide substandard care, and that evidence-based guidelines are a pretext for denying them the care they need and deserve.
Sigh.
Until we can retrain consumers (that would be all of us) to understand that in medicine more is NOT better, that evidence-based guidelines may translate in some instances into less but better care, that doctors are falliable and should be questioned, and that the cost of a treatment has nothing to do with the quality, we will never get out of the healthcare quagmire in which we find ourselves.
Your thoughts?
*This blog post was originally published at A Medical Writer's Musings on Medicine, Health Care, and the Writing Life*
I think this is an interesting point. As we deal with the healthcare reform changes, consumers will become more aware of the interactions with providers and the healthcare system. Costs should be tied to need, in that, we should be able to charge people for the cost of a procedure if they insist on it regardless of medical effectiveness. The more people have to pay for the over-use of care that they demand, the less they will demand it. Over time we should be shifting our focus to maintenance of care and preventive medicine, not necessarily the latest and greatest surgeries and miracle pills.
IMHO, a major problem with health care is that well meaning clinicians (treating docs) are admitting the patients into the hospital and then the differing incentives (between treating physicians and hospitalists) are evident.
Hospitalists want the patient discharged asap because the hospital reimbursement is for fewer days than the treating physician (if he were allowed to treat pt during admission).
Hospitalists have told me that their job is to save the hospital money. For example, the treating doctor knows the elderly man has a long history of UTI and “recommends” (bc he is not allowed to order) a urinalysis. But the hospitalist ignores the recommendation and performs only a urine dip stick test. The family takes the patient to personal treating urologist immediate upon discharge and the pt does in fact have a raging UTI that is too high into the body to be caught on dip stick.
Is that rationing of care? Is that hospitalist being arrogant? The patient is getting differing recommendations from the same medical team.