The New York Times published an editorial on June 2, 2012, “Treating You Better For Less.” http://www.nytimes.com/2012/06/03/opinion/sunday/treating-you-better-for-less.html
In the editorial, the Virginia Mason Medical Center in Seattle is noted for its rigorous internal reviews to eliminate waste and inefficiency. Now, doctors are required to click through a computerized checklist of the medical circumstances needed to justify a costly imaging test. So, the checklist is a block, an obstruction to doctors, who now must justify their clinical evaluations. Presuming that the doctors have absolutely zero financial interest in ordering the test, these are my thoughts:
First, an administration that is thinking of helping its doctors would clarify use of the checklist as an aid to look for reasons to order the test that doctors may not have thought of during their clinical evaluation (the history & physical) as opposed to making it an obstruction.
Second, money is the driving force behind these lists. Thus there is direct interference with the clinical functioning of the doctorpatient relationship because of the dollar bill. Practicing medicine with saving dollars on your mind is every bit as conflicted as the doctor who orders tests or does procedures solely because he/she profits from same. The latter is garbage medicine and so are these lists.
Third, to whom must the doctors justify their actions? Is it some administrator, who bows before the almighty insurance company? And who is it that constructs these lists? What is their knowledge base? Who pays the salaries of the people who construct these lists?
Fourth, this type of endeavor is SOCIALISM. These dollar based, greed-driven insurance companies, hospital administrators and others want the doctorpatient relationship to function in accord with some central authority, while pushing aside the fact that the essence of medicine and the reason so much medical knowledge has been accrued over time is the spontaneous functioning of the doctorpatient relationship.
Fifth, doctors conform because they are afraid not to, noting that GPs are much easier to manipulate than specialists because of the latter’s deeper fund of knowledge.
Sixth, this undermining effort to save dollars being a clinical modus operandi is now engrained in the medical consciousness of the USA by such clinically useless rhetoric as cost-effectiveness, managed care, medical homes, evidenced-based medicine and other verbiage. Patients may not have a clue as to what is really happening!
Hurrah for Seattle! Remind me not to get sick, if I visit there. Something from Canada must be contagious!
R. Garth Kirkwood, MD