"Those With More are not Happy..."

And now this study from Dartmouth Medical School as reported in today's Chicago Tribune:

"High rates of hospitalization, tests and specialist referrals lead to poorer patient outcomes when such things as degree of illness and death rates are accounted for. The researchers estimated that 30 percent of Medicare spending is waisted on unnecessary care. ... A major reason healthcare costs continue to escalate is that the system is geared toward paying for diagnostic tests, medical procedures, and other interventions and fails to reward personal contact with patients through which doctors can ascertain patients' problems more effectively and devise effective treatments..."

Just ask any physician I work with the amount of "screen time" they spend in front of a computer terminal versus the amount of face-to-face contact time they spend with patients, and you can't help but laugh that this research was required to expose what many already perceived: doctors are revenue generators, not care providers.

Medical students today are afflicted by the same dilemma: better documentation to assure reimbursement vs. better diagnosis through a thorough history and physical? You see it is far simpler (and some would argue better) to order an expensive CT scan to rule out intracranial bleeding than examine the patient for neurologic deficits. It takes less time for the provider and reduces liability (can you say "expensive defensive" medicine?). Add to this the fact that we "cap" the number of patients med students can see each day, so that we assure skills like time management and physical examination are not developed. News to med students: most of us are seeing more than 5 patients a day. Most internists see many more patients as an ever-increasing rush to see more patients in less time mounts due to declining revenues. Eventually, busy doctors become unhappy doctors.

So how do we change things? Imagine if physicians were compensated for returning phone calls instead of ordering another test, or discovering a physical exam finding that was diagnostic and avoided testing.

But as 'House' on Fox has taught us: if it's hoof-beats, think zebras instead of horses - it pays better.

But that's hardly a way to keep docs intellectually stimulated and happy.


--Wes