According to a recent survey, doctors think that more than 20 percent of medical care in the U.S. is unnecessary, writes Albert L. Fisher, M.D., of Oshkosh, Wis., president of the Association of American Physicians and Surgeons (AAPS), in the summer issue of the Journal of American Physicians and Surgeons.
He explains several reasons for this. One is defensive medicine: fear of lawsuits—or of hospital peer reviewers. There is an obsession with numbers and scores that serve to make the physician feel more secure and fend off criticism.
Teaching hospitals must take some of the blame. Medical education stresses state-of-the-art equipment, new protocols, and the latest research, he states. Medical residents are under pressure to do tests to prove a diagnosis. Bedside clinical skills become dull as doctors rely more on an imaging study than on history and physical examination.
“Patients suffer not only from their illness but also from the onslaught of tests and procedures,” Dr. Fisher writes.
Cookbook medicine can result in over-testing and overtreatment. For example, he writes that new hypertension guidelines would lead to 46 percent of the U.S. adult population being categorized as having hypertension. These do not take into account the potential harm of driving blood pressure ever lower.
The hospitalist movement also contributes to over-testing, Dr. Fisher states. “Patients are now cared for by hospital-employed physicians who have no previous knowledge of the patient, except what might be found in old records. Typically, this results in repeat testing and overtreatment. The patient’s own physician is not part of the new paradigm that denies the patient a trusted resource.”
On the other hand, Dr. Fisher notes that some degree of over-testing and overtreatment helps to ensure needed treatment. He advocates shared decision-making by physicians and patients. “Doctors and patients are encouraged to make prudent decisions about medical care with the use of a health savings account and a high-deductible plan.” Also, Direct Primary Care (DPC) is an innovative alternative payment model. “Patients are able to sidestep the massive insurance bureaucracy by use of health savings accounts and DPC,” Dr. Fisher states.
“The best chance of getting it right—that is, not too much or too little medical care—may well come from an independent doctor,” Dr. Fisher concludes. “The patient should be able to consult with an independent doctor who is not beholden to ‘the system,’ the hospital, the accountable care organization, or the government. As we focus on numbers, maybe it is the compassion quotient that needs to be raised.”
The Journal of American Physicians and Surgeons is published by the Association of American Physicians and Surgeons (AAPS), a national organization representing physicians in all specialties since 1943.
Read full article: http://www.jpands.org/vol23no2/fisher.pdf