Tuesday, July 28, 2009

A Nightmare Waiting In The Wings

My business is an ancillary service to the health care industry -- I'm not involved directly with patients, but I am privy to their complete and intimate medical symptoms, procedures, treatments and good/bad outcomes. Over the past 15 years I've seen a small number of documented physician errors and their consequence in medical malpractice lawsuits. I've also seen a whopping change in the philosophy and standards of patient care

Unless you have a history of the same chronic condition for which you've been treated over many years, your chance of undergoing an invasive procedure or very expensive scan of one kind or another is about ten thousand times greater today than it was even ten years ago. Even when a physician relies on his/her education, experience and common sense (for those few who use it), that provider will very often require that you get a scan "just to be sure" -- just to validate their conclusion -- and to cover their ass for malpractice exposure.

Have a belly ache? Get a CT scan. Headache? Hop up on that scanning table and let's "see" what's going on. A little red patch on your arm? Let's do a biopsy! PET scans, MRI scans, CT-guided biopsies and dozens of "oscopies" of one kind or another are as common today as an aspirin and thermometer were in the good old days. Of course these are all terrific diagnostic tools and undoubtedly save lives a thousand times over -- no argument there. But also of course, they are not without serious risks, their results are not foolproof, the tests themselves can be faulty and/or results misinterpreted, and oh, by the way, they are ALL horrifically expensive.... for your insurance company, for you as the insured, and for the taxpayers providing money for assistance programs.

The availability of all these diagnostics has changed the face of medicine and changed the method by which physicians practice their art. Undoubtedly the objective data these tests provide contribute to the quality health care that we receive. Also undoubtedly they are an enormous factor in the cost of that health care.

It's rare when a patient refuses or delays whatever test or procedure a doc orders. Even patients who have researched their own symptoms and are medically sophisticated rarely controvert the physician's request -- after all, they are paying for the doc's expertise and judgment, and after all, there might be "something dreadfully wrong" that can be fixed with drug therapy or surgery. It's been my experience that the only patients who don't comply with the ordered test or procedure are the terminally chicken or the uninsured. It always catches my attention when a patient puts a foot down, draws on common sense and says, "it was only a stomach ache, it went away after two days (while it took two weeks to get in for an appointment), and I feel fine now. Let's skip the scan." The doc, aghast, always documents that the patient refused valuable medical advice, assuring that the patient's eventual demise from that stomach ache will not end in a malpractice action.

I personally find it ludicrous that a $1500 scan will be ordered for a hangnail -- and I find it appalling and completely unethical that the number of scans ordered increases dramatically and exponentially when the doc's office has installed their own scanner. Ooops!

In all the recent blather about Obamacare and the astronomical costs of health care, I've yet to see this scenario mentioned, except in the even-more-frightening situation that a legislator or desk bound clerk may be making those particular medical decisions for us.

If you are at all concerned about the impending health care revolution we're facing, read THIS short and pithy article from Real Clear Politics. It will scare your pants off -- even if you weren't scheduled for that particular 'oscopy.

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