Thursday, April 17, 2008

Patient Problems

The other day I wrote about a report that pointed to the problem of overutilization as the key driver of rising health care costs. I mentioned some of the reasons for increased overutilization, including the perverse incentive of low reimbursement rates and the practice of defensive medicine. In addressing a similar issue, Dr. Sandeep Jahaur, writing for the New York Times, mentions another one: patient expectations --

Not long ago, I visited a friend — a cardiologist in his late 30s — at his office on Long Island to ask him about imaging in private practices.

“When I started in practice, I wanted to do the right thing,” he told me matter-of-factly. “A young woman would come in with palpitations. I’d tell her she was fine. But then I realized that she’d just go down the street to another physician and he’d order all the tests anyway: echocardiogram, stress test, Holter monitor — stuff she didn’t really need. Then she’d go around and tell her friends what a great doctor — a thorough doctor — the other cardiologist was.


“I tried to practice ethical medicine, but it didn’t help. It didn’t pay, both from a financial and a reputation standpoint.”


That happens all too often.

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