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Health Care Dilemma | Who is Responsible?

Many physicians believe that demanding patients are the reason they are delivering so much unnecessary care. Patients insist on getting a prescription for a drug they saw advertised on TV, or on getting an unnecessary and pricey imaging test, such as a CT scan. Doctors fear that the patient will leave them for another physician or because explaining why a drug or a test is unnecessary takes too much time. You have a patient who comes in with hearing loss. It might be an acoustic neuroma, a very rare [slow-growing] tumor. Some doctors order an MRI for every patient who walks in the door complaining of hearing loss. But a more rational approach is to explain to the patient that there is only a small chance of a tumor. The doctor should say, “Let’s check your hearing in six months.” But many doctors don’t do that, because they worry the patient will go to a physician down the street, who will find a tumor, and the patient will turn around and curse the doctor who suggested waiting. There are other hidden forces pushing over treatment. In many private facilities there are more specialists and more hospital beds than necessary, and the doctors tend to practice more-aggressive care, hospitalizing patients unnecessarily and referring their patients to other specialists, who then perform more unneeded procedures and tests. Sometimes, providers deliver unneeded care because they get paid more when they do more. Most of our caregivers are still paid through a system known as fee for service. They are reimbursed for each office visit, each day a patient spends in the hospital, and each test or surgery performed. This means that health care providers have every incentive to give patients more care, not better care. In our part of the world doctors are the professionals devoting most of their lives to service but they are not getting fair economic returns and privileges. Their minds are being polluted by the corporate culture of pharmaceutical industry and the deprived doctors find them a last resort to maintain a respectable lifestyle for themselves and their families. The insensitivity of our system towards health care has also increased the cost of health care and the doctors find themselves sandwiched among health managers and consumers.