Are patients making things worse?
NPR had a story this morning that grabbed my attention. It’s something I’ve thought about for years. Every time I go to the doctor, in fact.
From “How the modern patient drives up health care costs:”:
The fact is that the behavior of patients in our health system has changed dramatically over the past couple of decades. They’ve transformed from passive “patients” who almost blindly follow the doctor’s orders — until the 1980s, patients regularly took pills without even knowing what they were for — into active and aggressive “consumers” of health services.
People read things on the Internet. They see prescription ads on TV. They become convinced they have an ailment. They tell the doctor. The doctor doesn’t think the patient needs the test, but they’re afraid to say no. And there’s not much time to argue about it:
“There is a drive to get people in and out because insurance reimbursement is very difficult,” (Dr. Teresa Moore) says. “So even though it is absolutely wonderful to say we could spend 30 minutes with each patient and explain these things fully, sometimes you just don’t get to do that in real life.”
So doctors will order you tests you don’t need. And they will write you prescriptions for pills you probably shouldn’t take — which is a huge problem with antibiotics, for example.
And, (Dr. Joseph) Zebley says, doctors even do operations, like back surgery, that they probably shouldn’t do. They do it, he says, because you want it, have become convinced that you need it, and doctors fear that if they don’t give it to you, they’ll lose you.
But not all doctors are like that. I went to mine recently complaining of shoulder pain. I had been living with it for a while. A massage therapist warned me about frozen shoulder. I did some research online, and it sounded horrible. I went to the doctor convinced that I was well on my way to frozen shoulder and that I might need surgery.
He said: “Scott, you don’t need a hammer to kill a fly.” Instead of ordering expensive tests, he told me to take prescription strength Alleve for a week.
A week later, the pain was gone. I’m glad the doctor stood his ground.
I can think of other examples where I’ve resisted tests because I thought they were unnecessary, and I was right. I like being a more active patient. I remember the days of thinking, “the doctor will fix it,” and I’m glad I don’t have that attitude anymore. At the same time, patients need to be part of the solution for keeping health care costs down.
NPR’s story ends with this:
If you ask Moore if she would rather have an old-fashioned, passive and pliant patient or a new, demanding and modern one, she really has to think about it.
“It depends on the phase of the moon,” she says. “Passive is much easier to treat. But I do like an educated patient who’s willing to read about their health issues. So I guess I’d like someone in the middle.”
Your thoughts?
- Oct 12, 2009 8:26 AM — Scott Jagow
- 7 comments
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Comments (7)
October 12, 2009 11:25 AM PT
Scott,
You’ve hit the nail on the head. Many patients view healthcare as “free” because insurance is already paid for; it’s easy to ask for those expensive tests. We are relying on our doctors to advise us, but they have a conflict of interest in many ways (not because they are greedy, but because sometimes it’s easier to go along than to say the patient doesn’t need this).
We’ve also disconnected our incentive and costs from our consumption. (It’s not a free market system!) Next year when our premiums go up, we wonder why the costs are going up, rather than remembering the unnecessary tests we’ve ordered.
Prior to the 90’s, all those TV ads for drugs weren’t legal. Funny how pharma companies started raking in lots more cash when advertising laws were changed.
Most patients would be much better served by a plan that covers basic preventative care and catastrophic coverage while still having an incentive to reduce costs in routine care. This can be provided in so called “consumer driven care” or Health Savings Account plans. Saved costs would go directly into the employee’s pocket. Talk about incentives!
October 12, 2009 2:07 PM PT
Scott,
I think patients can make the health care system worse in the way the story describes. Please forgive me if I don’t gracefully or tactfully segue into an idea that may easy the problem. Why not make it easier for people to spend their time and money not only reading/researching their symptoms on the internet but also ordering and paying for test they would like to have the results for WITHOUT a Doctor’s order.
Why is it that more or the diagnostic tests are not casually available to the interested “public” consumer. My sense of it: that would drive costs down. Why do so many diagnostic test need to be categorized within the medical healthcare system? I would be interested in knowing more about the “condition” of my bodily systems. If they were readily available outside this conceptual model (medical healthcare) I think others would be interested in using value added “navigational” information.
It seems a bit strange that for the most part people need to be “patients” in order to get this “health” information. Maybe there is some value in using personal transportation (car; bike; motorcycle) as an analogy. The cost of diagnostics would probably be higher if we needed the equivalent of a Doctor’s prescription for diagnostic test for our other vehicles (car; bike; motorcycle). I have not heard the idea/argument for more freely available information via de-medicalizing much of this technology – have I simply missed it?
October 12, 2009 2:24 PM PT
Michael, the FDA has opened that door quite a bit wider in recent years. It has approved home diagnostic tests beyond just at-home pregnancy tests. Of course, there’s still a lot of debate about it in the medical community. But the market exists and has been growing. This article is from a couple years ago: http://tinyurl.com/ylasezc
Still, I haven’t heard any discussion of this during the current health care reform debate.
October 12, 2009 6:01 PM PT
You’re not going to hear anything in the current health care reform debate about it because it doesn’t allow for more government control.
nyet: responding to Scott Jagow | RespondOctober 13, 2009 8:16 PM PT
Reposting Scott’s url since I never trust url shortener service
http://www.seattlepi.com/health/264716_hometesting29.html
October 13, 2009 9:48 AM PT
While this is undeniably true, I think it’s missing the point. With all the finger-pointing between the two sides of the health care debate people are missing the fact that BOTH sides are at fault.
Patients read about Fibromyalgia on the internet and become convinced they have it, then demand that their doctor treat them for it (or test for it etc.) (A little knowledge is a dangerous thing.) Doctors hear upset patients and want to help them, but also are afraid to tell the patient “no” in case they are wrong.
So we get a perfect storm of poorly informed pushy patients and milquetoast doctors afraid of lawsuits combining to create poor care and insane health care costs.
Add to that the insurance companies who are incentivized to support tests by being allowed to raise premiums and co-pays without limit and we’re screwed.
October 13, 2009 10:10 AM PT
Our modern drugs can do wonders—things you couldn’t expect years ago. But advertising name drugs on television, even with side-effects, neglects the lower cost of equivalent generics. Lipitor, my pharmacist says, is no better than the generic for reducing cholesterol. Consult your pharmacist, not just your doctor. And doctors should do us all a favor by saying “no” to requests for ineffective or expensive remedies when rest, time, and aspirin do just as well.