America’s Doctors Need to Look in the Mirror
Doctor, Doctor, Mr. M.D. –
What’s Ailing Thee?
Doctors in America generally perceive themselves as victims. They’re victims of overly-aggressive lawyers and a litigious culture, of insurance company rules and restraints on their practice of medicine, of government intrusion and non-compliant patients. “Woe is me” is their implicit mantra.
This is borne out by a recent survey of doctors that indicated the vast majority of doctors blame everyone but themselves for America’s medical spending crisis. This survey was a follow-up to another survey published in JAMA that found exactly the same thing – doctors pointing the finger at everyone but themselves.
Of course, you might think our healthcare spending crisis is no longer a threat with misleading headlines like last week’s “Healthcare Debate: Why Are We Spending Less?“. We aren’t, of course – healthcare costs are just growing somewhat more slowly than they have in the recent past. They continue, however, to exceed other family and business costs and we are most definitely NOT spending less on our healthcare.
And far from being the blameless victims they perceive and portray themselves to be, America’s doctors are the driving force behind our medical misspending. They may not always – or ever – like the rules of the road, but they remain firmly in the driver’s seat.
And that means they need to stop the finger-pointing and start taking responsibility for America’ healthcare spending – and misspending.
Hard Fraud/Soft Fraud
I write extensively in Our Healthcare Sucks about the role that fraud plays in America’s healthcare. We all know about the overt fraud like that recently disclosed about ambulance services.
Much of this, though not all, is illegal – and one consequence of the across-the-board sequestration cuts to the federal budget is that even illegal fraud will be prosecuted less aggressively.
But there are also layers of legal, though highly unethical, fraud that permeate the very practice of medicine itself.
Take, for example, the GAO’s recent announcement that it’s targeting physicians who invest in radiation treatment facilities and refer patients there more aggressively only after such investments. This practice of so-called “physician self-referral” is common across America and clearly demonstrates the primacy of monetary reward over patient safety for those physicians who engage in these practices.
It’s legal, but ethical it ain’t.
Defensive Medicine’s Offensive
Then there’s the much more common practice of defensive medicine in which over 90% of doctors surveyed admitted to practicing in a survey I discuss in Our Healthcare Sucks. I note there that medical malpractice claims are at record lows – a trend that’s only continued, as announced just this week.
Some have decided that medical malpractice isn’t responsible for our medical overspending, but they’re as wrong as those claiming our healthcare costs are declining. What they overlook is that it’s not the direct costs of medical malpractice that are the problem as much as its indirect costs. It’s physicians’ inordinate, exaggerated and often borderline pathological fear of malpractice risk that drives so much unneeded medical testing and invasive procedures.
In addition to these human failings of fear and greed, there’s the calculated systemic fraud in which doctors are paid for their services based on inflated estimates of the time required to perform them. This government-sanctioned process allows physicians to recommend their own payment rates based on recommendations by a committee composed exclusively of physicians. And now there’s evidence that these recommendations are purposely bloated to pad their incomes. What a shock!
This may be legal – and even government sanctioned – but it’s a whole bowl of wrong.
Against this backdrop of dubious physician behaviors, how is it possible that doctors blame everyone but themselves for America’s medical misspending?
Caught with their hand in the cookie jar, their collective response is “Who, me?”.
Instead of pointing fingers at lawyers and insurers and even at patients, maybe America’s doctors should take a good long look in the mirror.
A little self-reflection and self-imposed reform would go a long way to getting our healthcare spending on a more sustainable path.
That’d be good not just for patients, employers and government budgets – but for the medical profession itself.
Because the current path they’ve chosen of denial, defensiveness and obfuscation isn’t likely to end well – for anyone.