DISQUS

Alexy_Inciarte · 6 months ago

Want to bet what happens? I'll tell you what would happen. Your patients would see far less action in the hospital, ASC, radiology suite, clinic and any other health care site you can imagine. And they would experience no drop off in quality. Why? Because the doctors would take care of patients for the right reasons.

that experiment is a reality in my country, you know venezuelan doctors are payed on public service, not for the amount of patients or test we see or do, we got an standard income regarless the cuantity of patients and test.

this is my work from 480 to 570 patients for 400 dollars monthly. i agree that testing shouldnt be charging, in my work most of doctors will ask for unnecessary testing, not because they are gonna be payed more, because the patients and the doctors are used to it, because they lack of knowledge when to order the right test, lack of physical examination, but I agree with you if you eliminate money as a motivator unnecessary testing should be reduced, still you wont eliminate overtesting 100%, but is gonna get reduced. on the other hand, having standard incomes, despite of the number of patients, make doctors feel less interested on them, i have endless examples, of this Pneumo and Cardio Docs arguing, its not my patient is yours CardioD says: "he got COPD" PneumoD says: "He got CHF", if it was a private service is different, you get payed for each patient, you would see specialist taking patients beyong their scope of practice, just to earn more money.

i guess it would be interesting compare your hospital rates of testing with ours, but i bet our populations would be so heterogenous and there are many variables involved to even compare or make a proper conclusion. very interesting post.

Bo... · 6 months ago

Very well written.

Bianca Castafiore · 6 months ago

I've checked and double-checked, concerned for my sanity -- but it's true:

Great post, Happy.

The Refugee · 6 months ago

I read that last week.

I want our president to respond to that article and tell us how his brilliant ideas for reform are going to change that equation.

Anonymous · 6 months ago

Dear HH,
An excellent companion piece to the Gawande article. So full of emotion. I hope you submit it as an anonymous Op-Ed piece for the NY Times or other newspaper paper.

David MD

scalpel · 6 months ago

What's only briefly mentioned in that article is that McAllen (and South Texas in general) was previously one of the most toxic malpractice climates in the nation. Now we have outstanding tort reform in Texas, but those practice patterns were formed during the worst of the crisis. So my theory is that the local standard of care evolved from a suffocating need to practice defensive medicine to the extreme. Thus the overtesting and overtreating.

Katie Bee RN · 6 months ago

Well written. A colleague and I were discussing this article, and it reiterates for the me the fundamental thing about our health care system - that it is for profit - will prevent it from being "reformed." I like your ideas. The only way to change behaviors and create a paradigm shift for HC in this country is to make people pay more for what they "want" or get. No it's not "fair" but hitting people in the check book is the only way you make them change.

Anonymous · 6 months ago

Nurse K--Hold on.
Not yet.
Step away from your keyboard.
Allow me...

I think this piece is fascinating coming from HH.
I believe I read on this exact blog not too very long ago,a very small history of a few vague complaints like HA, fatigue, nausea.
Things we primary care docs never ever see.
Makes all of us immediately think of a Dr House consult.

And then I saw a list.
Generated by our very own HH.

A list of 20+ tests.
A list of tests to rule out every esoteric disease under the sun.
A list including pan body imaging.

A list recommending both CTs and MRIs.

A list that defined fishing expedition.

A list that said I have no idea what you have, but I can test you for everything because this may be.....(fill in your favorite rare disease you loved in med school but have only seen once in residency during your medical service rotation in West Africa.
)
A list that most certainly would have turned up several false positives and incidentalomas.
That would most certainly have led to many unnecessary procedures.
That would been right at home in McAllen Texas.

Pot?Pot?
Is that you?
This is kettle.....


And then goes and writes about medical waste.
A gem. A true gem.

The Happy Hospitalist · 6 months ago

anon. If you are in the medical field, and now anything about hospitalist medicine, you would not be writing this. Since I know what I'm talking about, I also know I'm right in the context of the work up I described.

Alexy_Inciarte · 6 months ago

Anon 1204 are you the one that previously bashed, Nurse K, at scalpel blogs; I bet you are the troll dude; maybe, happy put those entire tests gathered together, because he didn’t do any assessment and physical examination to rule out the 90%. Basically this was an ? Patient, nothing is known about him/Her. He just put the broad spectrum with the available data (which was almost nothing), I doubt happy ordered that 1 million $ work up, to all the patients with the similar complains in a real consult.

Anon is in the medical field indeed, he is a doctor, maybe an specialist, not an internist an internist wouldn’t talk that way.

Anonymous · 6 months ago

As an aside, this article has apparently caught the attention of the Democratic leadership in the House and Senate and a copy of it sits in the President's desk. I suspect the bludgeon against all of the "greedy doctors" (read: all doctors) is coming.

Buckeye Surgeon · 6 months ago

The Gawande article is off the mark. I rambled on about why on my stupid blog. The ER doc isn't financially motivated to order MRI's on patients with chroinic back pain. The GI consultant doesn't get money from the HIDA scans, CT angiograms, and gastric emptying studies he orders. The ID guy doesn't get paid off by the pharm company for recommending the most expensive broad spectrum antibiotic.

The problem is overutilization but it isn't (for the most part) driven by physician greed. Mostly, we just don't think. Some of it is laziness, some fear of lawsuits. But what we need to change is how we go about practicing the art the medicine in such a way that is both medically appropriate and socially conscious (i.e cost effective).

Take care.