Line from a conf

10 Responses to “Line from a conf”

1. Jon Husband, on November 10th, 2009 at 1:41 pm Said:

   Pretty good one.

   Even better if there are ways to ensure they are hungry before you move the food ?

 

2. davidw, on November 10th, 2009 at 3:31 pm Said:

   Even better, it was in the context of changing health care by “realigning” the incentives. Actually a pretty good little metaphor.

 

3. Jon Husband, on November 10th, 2009 at 3:33 pm Said:

   I get that. Yes.

 

4. Jon Husband, on November 10th, 2009 at 3:37 pm Said:

   Re: health care .. I remain fascinated by the differences between the YSA and Canada (here).

   I’ve read one too many stories / articles about the incentives for doctors in the USA to order many tests, etc. (context is the ‘versus salaries for doctors’ discussion).

   The usual argument is the litigious environment in the USa re: liability, but I have read a number of articles that suggest / state that the actual incidence of legal actions is actually quite small.

   I wish more Americans knew how the health care system works up here. Not perfect but pretty good, and I suspect that any Prime Minister that tried to rid this country of it would be hung, drawn and quartered.

 

5. Andrew Weinberger (yes, I am related), on November 11th, 2009 at 8:54 pm Said:

   Most physicians I know (including me) get NO financial benefit from ordering tests. I do not get paid by anyone for ordering blood tests, x-rays, MRIs or any other test. In fact, whenever I order a test, it means extra work for me for which there is no pay. This could include getting authorization for the test if needed, reviewing and interpreting the test and, for me, reviewing the x-ray films. Then there is the phone call(s) to the patient about the results and possibly a note to the primary doctor about the test. These steps can take immense amounts of time for which there is no financial incentive.

   This is not to say that I think we have an efficient or equitable health care system, however. We do not.

 

6. Jon Husband, on November 11th, 2009 at 9:15 pm Said:

   Thanks for the clarification, Andrew. Obviously there is much misinformation out there (I read it on the Internets).

   I am glad to know this is the case with most physicians you know.

   I must point out that the pieces I remember reading did not suggest that the primary motivation was for financial benefit, and obviously I was being sloppy by using the word :incentives: above. The main suggestion I recall regarding intent or reason for extra or perhaps unnecessary tests was in order to avoid being accused of not trying everything or of overlooking some potential cause .. which is very different than attributing any motivation for obtaining financial benefit.

   So, the above comment was me being sloppy. I also cannot claim to have any unvarnished truths or unique insights that I know to be true about the system in the USA. I do not. I can only try to understand the similarities and differences from what I read. I try to be careful and informed. There’s a lot (and a range of quality) of information out there.

   I don’t doubt that some doctors in the USA seek ways to maximize income, and believe they deserve every cent of it.

   I also do not doubt that very many doctors in the USA do what they do primarily for the love of the field of medicine and the privilege of holding peoples’ trust while the work together to make each and every patient they see live a healthier and thus more fulfilled life … even though they (or their staff) must wrestle with the onerous aspects of what must be a byzantine system of administration.

   My fondest hope would be that all humans in each country around the world would get solid quality basic health care as a human right. It is, for me, the essence of what it means to live in a civil society to pay the taxes that support a health care system that is accessible to, and equal for, all.

 

7. Andrew Weinberger (yes, I am related), on November 11th, 2009 at 11:31 pm Said:

   “My fondest hope would be that all humans in each country around the world would get solid quality basic health care as a human right. It is, for me, the essence of what it means to live in a civil society to pay the taxes that support a health care system that is accessible to, and equal for, all.” Well said.

   I did not mean my response to sound critical of your reply; I was only trying to clarify what is not clear to many people, including US residents and people elsewhere.

   It does seem that some doctors do some tests only to be sure something is not missed to avoid possible legal problems, but in my limited view of the world I don’t think I see as much of this as people think. I see more tests wasted by doctors ordering tests because they think it will be helpful or because they do not know enough, or trust themselves enough, to rely on the history, the examination and basic tests. Sometimes tests are ordered to speed up an evaluation that might have been done in another, less expensive way. Then there are the requests from patients for tests that may not be appropriate, and that are not always refused. Testing is a very complicated area for which I have no objective evidence or particular expertise (that does not stop me from mouthing off, however!).

 

8. Jon Husband, on November 12th, 2009 at 9:44 am Said:

   I did not take it as critical, Andrew .. but I also don’t like to mouth off (especially when I don’t know much about what I may be talking about), so I appreciate your bringing some additional information and reason into this brief exchange.

 

9. davidw, on November 12th, 2009 at 10:54 am Said:

   Two things.

   First, the health care folks at the little private seminar I was at, including the physicians, agreed that tort reform was unlikely to make much of a difference because health care folks generally do not change their behavior in order to avoid suits; rather, they generally decide based on what they think is best for the patient.

   Second, Jon, you should know that my brother is probably the most ethically driven person I know, as well as one of the most compassionate. (He was also chosen Rheumatologist of the Year by the NJ Rheumatology association 2 yrs ago.)

 

10. Jon Husband, on November 12th, 2009 at 10:59 am Said:

    Re: your first point, thanks for the additional clarification. Thank goodness for the Hippocratic oath and the caring impulses that drive most peoples’ decision to become doctors.

    my brother is probably the most ethically driven person I know, as well as one of the most compassionate.

    Don’t doubt it, not surprised.

 

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