Following the Fallout from Defensive Medicine

Many pieces have been written over the years about defensive medicine and how it raises the cost of health care and provides unnecessary care to patients. But, a recent article in The New Yorker takes this information a bit further. “Overkill,” by Atul Gawande shows us how such care is actually harming patients both physically and financially and asks, “What can we do about it?”

Even with health insurance, financial costs for medical care for families can be crippling. Between high deductibles (which can be in the thousands of dollars) and co-pays (which can often run into the thousands of dollars, too), one significant medical event can bring a family to its knees. WITH INSURANCE!

Dr. Gawande specifically talks about a recent, large-scale Medicare study that showed how “virtually every family” in the US has been subject to some kind of over-testing or over-treatment and how the costs take thousands of dollars out of the pockets of these households each year. Researchers are now associating this unnecessary care with financial and physical “toxicities” that result in reduced spending on basic needs like food, clothing, shelter and/or education.

Dr. Gawande goes on to explain that the occurrence of over-testing partly exists due to the uneven nature of the doctor-patient relationship. Physicians naturally know much more about the goods and services being offered to the patient than the patient. Thus, it is almost impossible for any sort of checks-and-balances to exist unless second opinions are gotten, which often, they are not. And, often the additional procedures are just “fishing expeditions” where an abnormality is found –though it does not necessarily explain the original problem nor does it necessarily need follow-up –yet, again, additional follow-up is often sought, potentially adding thousands more dollars to the patient’s bill, though for no real reason other than because we can. In addition, many of these procedures are often with their own additional risk and result in missed work for patients, adding additional financial strain.

Many other problems with the health care system are also discussed. Overdiagnosis, not to be confused with misdiagnosis, is tackled by Dr. Gawande. While diagnosing seems like a good thing, he argues that too often we are diagnosing “turtles” slow growing problems that don’t necessarily need immediate attention or lots of follow-up, though we are often conditioned to immediately provide it and patients have been conditioned to expect it. The problematic piecemeal nature of the field of medicine is, too. Often times, physicians refer patients for services that they don’t provide, and therefore, frequently don’t know how much they cost, so they are unable to balance cost with benefit. So, while home health care may seem like a good idea, it is also a very costly one. But, how are physicians who don’t bill for that service expected to know that?

See the article for the full discussion of this important topic.

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