Wednesday, August 31, 2011

Shopping for Medical Care

A recent article in the highly-regarded New England Journal of Medicine began with the following sentences: "Most physicians want to deliver 'appropriate' care. Most want to practice 'ethically.'" (N Eng J Med, Aug 18, 2011)

Isn't it interesting how the author divides the medical profession into two groups: Group 1 - those who practice appropriately and ethically and Group 2 - those who apparently do not. The author does not give us any indication as to where the dividing line lies. Is the Group 1/Group 2 ratio around 90/10, or is it closer to 60/40? I hopefully and candidly believe he is alluding to the first ratio rather than the latter.

Today physicians are frequently referred to has "health-care providers" and their patients as "consumers." Merely the use of these terms has, rightly or wrongly, helped move this encounter from "doctor-patient" to "product-shopper." When one "shops" one considers a number of possibilities before purchasing. Hence the "second opinion" and sometimes even "the third (or more) opinion."

Not that there is anything wrong with that!

As some products are better than others, so are some doctors better than others. In calculating the cost of medical care, I have seen no data that speak to the cost of such "shopping." When such costs are discussed, it is assumed that one family practitioner or specialist is no different from another. We physicians know, in fact, that this is far from factual, and so do our patients. And so the "consumer (patient) shops."

But in doing so, our consumer-patient must recognize that this, too, will necessarily add to the general expense of medical care - whether it is governmentally or privately provided. Controlling health care costs is very difficult for a society that will shop for the best and the brightest who deliver appropriate care in an ethical manner!

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