Tuesday, November 26, 2013

The Three Considerations in Medical Care

Your health care requires three significant considerations and decisions on your part (not in any particular order).

1.  Cost and availability
2.  Expertise of providers
3.  Whether treatment is really required.

The Affordable Care Act is primarily, if not solely, concerned with the first of these.  It's intent is directed at making health care "affordable," as is clearly stated in its title.  I am not getting into the pluses and minuses of the act, except to say that I feel very strongly that everyone is entitled to basic health care, and it is the responsibility of a government to insure that such care is available to all citizens - as it is for the availability of a citizen's personal security (police and military "care") or the security and safety of his body and property (fire and safety "care").  Though military, police, and fire services are expensive, the cost is not borne by the individual directly, but indirectly via the tax structure.  Therefore the expense is not "felt" as is the case in medical care.  For the record, I am in favor of a form of single payer system, so common in most other developed countries, but available in our country only for people who have reached a certain age, or are below a certain income level.

The Affordable Care Act does not help you determine the expertise of the providers.  Medicine, is a provider-based service, not a product.  Various agencies, governmental or private seem to regard it as a product and wish to furnish you with the "product" at the lowest possible cost.  But there is variability in the expertise of the medical providers, which is just as important, if not more important than cost and availability.   Is your physician skilled at recording your medical history and performing your physical examination?  Does he know which tests to order and, perhaps more importantly, which tests not to order?  Is your surgeon skilled at the surgical procedures he may be advocating?  Additionally, much of medical practice today is guided by evidence-based medicine - recommendations for management of sundry medical diagnoses after evaluation by committees of universally regarded experts.  Physicians should be aware of, and should be following these recommendations, which are based on numerous well-researched published studies.

Lastly, and perhaps most importantly, is the question of whether or not the advocated treatment is really necessary?  A patient should be properly informed of the risks and benefits of the advocated therapy as well as the risks and benefits of no therapy.  Not everyone who is referred for heart surgery actually requires it.  Not everyone who is told to have a colonoscopy really needs it.  Not everyone is informed that surgery is not always the solution to a back problem.  Be aware that medical errors leading to death may befall some 400,000 patients a year,  according to a recent study in the Journal of Patient Safety.

Get all the information you can about cost, expertise and necessity.  If you feel uncertain, find someone to guide you.  Provide yourself with some basic knowledge of medical statistics to help you ask the appropriate questions when visiting your physician.  And try to have someone accompany you to help you understand what you are being advised to do and why.

1 comment:

Debra Turner said...


A very well written, practical bllog for us all.

I also enjoyed the interview you gave regarding health care reform and go back to read it at times. Let me leave the link for it here: http://thesavvvyshopper.blogspot.com/2011/01/health-care-reform-doctor-weighs-in.html.

Thanks for your prospective!