Tuesday, June 10, 2008

Disgusting Medical Practices

Police in Italy have arrested 13 doctors from Milan for performing needless medical surgeries. The doctors collected some $3.8 million for performing these surgeries. What's worse, is that wiretaps placed reveal that the motives for the surgeries were most likely for monetary reasons.

I hope this doesn't surprise you. And, I hope that you are not comforted by the fact that this occurred in Italy and not the U.S. In my young medical career, I have already seen too many examples of doctors performing unnecessary tests and procedures, or trying to extend the life of patient whose outcome is futile. The financial incentive is too corrupting (most tests, procedures, longer hospital stays means more billing and more money in the pockets of physicians). Also, there is a "secret mafia" of consultants/specialists who refer patients to each other to increase their revenues. Finally, don't forget about all of the incentives placed in front of doctors by pharmaceutical companies. While the rules have become stricter, you can imagine that there are still underlying pressures and enticements. This is one of the reasons why so many people are taking over 20 medications.

What does this mean for you if you are a patient?

1. The next time your doctor orders a test, ask him why it is necessary and how he/she will act on the information. There are so many tests that are ordered that do not change your medical management whatsoever.

2. The next time you doctor orders a radiographic test, again, ask why, and what the alternatives are to the test. The reason for extra caution here (as opposed to a blood or urine test) is that you should not be exposed to extra radiation if you do not need it (FYI, a standard CAT scan delivers more than 200x radiation than that of an X-ray). Studies have shown that the radiation increases your risk for cancer.

3. If a surgeon recommends an operation for a non-emergent condition such as chronic back pain(not for a ruptured appendix or cholecystitis, or something emergent and obvious), get a 2nd opinion. Remember about the financial incentive to operate.

4. Ask your doctor if all of the medications that you are taking are needed. Sometimes medications are continued for a previously indicated condition, but your change in health status may no longer require it.

5. Fill out a living will and make sure your loved ones have one in place. The default in the hospital is to do everything. Couple that with the "God Complex" that many physicians have, and before you know it, there will be tubes going into every orifice in the body, and all kinds of aggressive and largely uncomfortable procedures that will follow when illness strikes. Do this living will when you are feeling healthy and are of clear mind. Try to remember that death is not optional, and try to balance out with extending your life on Earth with your QUALITY of life.

6. Be skeptical!! This is not the 1950s when everybody used to take what their primary doctor said as Gospel. There are a lot of bad doctors out there who barely made it through med school or barely passed the boards (many are not even board certified, but are still practicing medicine). Look up your conditions on the internet. Become educated, and have an active part in your health care decision making. Remember that doctors are busy and may miss things. But, I still think that you are more likely to get more unnecessary care than lack of vital care, given the ease with which tests in this country can be ordered.

I've said this in the past, but I think there are way too many financial incentives in the health care system. Everybody is trying to make money: doctors, hospitals, insurance companies, and pharmaceutical companies. With all of the green to be made, patient's needs and desires are often last on the list of priorities.


Will said...

Steve -- great job w/ the hyperlinking. Now we need to work on finding some funnier cartoons.

and, hey, let's be honest about the living will situation. It's by no means a solution to the futile end-of-life care mess. Not that I discourage people from getting them but they have limited relevance in the inpatient/ICU settings. Appropriately, providers are required to ask the relevant questions about end of life wishes with every hospitalization. The sad part is that rather than making this a meaningful exercise, it seems that many hospitals just ask 'do you have a living will?' so they can check off the box on their stupid JHACO review.

The real need is for 'goals of care' discussions with patients who have chronic diseases that aren't traditionally thought of as 'terminal illnesses.' And I guess those discussions need to happen in primary care where they rarely do. Ughh, this a big mess..

kath said...

Wow, how sinister the medical community is!

On the one hand, I understand what you are saying but on the other, I don't feel like you are painting a fair picture. I have no doubt that unnecessary surgeries take place in the US frequently but have to believe this is the minority of cases. I know this would be a difficult area to have data b/c of its very nature but if people read your post before going into the ICU, we will never get any of our care delivered in a timely manner b/c we'll be too busy assuring patients that we are not trying to cash in at their expense!

On the other hand, I have had the misfortune of having to be on the receiving end of health care personally (nothing bad...the baby boy!) and as a family member (not so good). No doubt, there are bad doctors out there who retain that god complex (my uncle's doctor told me he was doing more than his job by calling my family on a Friday night at 10pm. Mind you, he was on call that weekend but he saw himself as being a martyr.). And I have a new appreciation for why patients and their families sue. It's not about the money at all but about trying to make that callous, inconsiderate person feel SOMETHING, even if only in ther wallets.

OK, sorry for that rant. But here's my bottom line on the medical profession: We need to establish a more transparent system with more meaningful regulatory systems, starting at the med school/residency level. I'm sure we can think of more than a few people who graduated from our residency but shouldn't have. I also think doctors should be better organized at the national level.

Oh, and have you all heard about doctors being scored on Angie's list?

NPR's On Point is doing a story on excess pharma in the USA, compromised MDs and advertising. Very timely as always, Steve!

Don Martin said...

I love how you post an article about unnecessary surgeries under SOCIALIZED medicine in ITALY to support a rant about how awful our medical system is in AMERICA.

Thanks for convincing me that I don't want a major overhaul of our system here.

Thank God (sorry if that word offends anyone) we are not like Europe.