http://www.huffingtonpost.com/andrew-weil-md/fear-greed-and-x-rays_b_270828.html
Physicians like to discuss the fear side, because it shifts the blame to lawyers. The greed side, however, deserves just as much scrutiny and reform. Consider "The Cost Conundrum: What a Texas town can teach us about health care," a must-read New Yorker article by Atul Gawande, M.D. Gawande visited McAllen, Texas, to discover why per-capita health care expenditures there are the highest in the nation. He found that many physicians in high-medical-cost cities such as McAllen have a diversified "revenue stream," the result of what one hospital administrator termed "entrepreneurial spirit." This "spirit" often manifested in physicians owning their own medical testing equipment, which meant the more tests they ordered, the more money they made. A 2002 University of North Carolina study showed doctors who own imaging equipment sent patients for roughly two to eight times more imaging tests than those who don't own.
In Gawande's article, a McAllen doctor who refused to hop aboard this gravy train had a more sensible take on the local "spirit." "Medicine has become a pig trough here," he said. "We took a wrong turn when doctors stopped being doctors and became businessmen."
Lest you think the only drawback of over-scanning is wasted billions, note that from 1980 to 2006, per-capita radiation dosage from medical testing more than quintupled. A controversial study published in the November 29, 2007, New England Journal of Medicine estimated that computed tomography (CT) scans -- the type of imaging that has grown most explosively -- administered today could eventually cause up to 2% of cancer deaths.
As with fear, greed also propels expensive, inappropriate treatment. If a clinic loses money each time it counsels a patient to control type 2 diabetes with diet and exercise, but makes a hefty profit when it amputates a foot riddled with diabetic ulcers, how long will it continue to emphasize the former?
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