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From: sm@cadre.UUCP
Newsgroups: net.flame
Subject: Re: People who gouge others for profits (VERY LONG)
Message-ID: <198@cadre.ARPA>
Date: Thu, 24-Jan-85 01:33:59 EST
Article-I.D.: cadre.198
Posted: Thu Jan 24 01:33:59 1985
Date-Received: Sun, 27-Jan-85 07:48:19 EST
References: <187@abnji.UUCP>
Reply-To: sm@cadre.ARPA (Sean McLinden)
Organization: Decision Systems Lab., Univ. of Pgh.
Lines: 149
Summary: 

I wouldn't normally reprint all of a letter, but this was significant
enough to deserve comment:

In article <187@abnji.UUCP> jca@abnji.UUCP writes:
>There has been a recent discussion about how lawyers gouge their clients,
>and society in general, for their own profit.  I would suggest that there
>is a group even worse:
>
>Doctors.
>
>(Not the elderly types, but the new breed of doctor, ie less than 40 yrs old.)
>
>Remember those premeds back at your universities?  The type of person most
>likely to succede is the type you'd least want as your Doctor- The unscrupuous
>money grubbers who would do anything.  (I remember one who sabotaged others
>Organic Chemistry experiments by putting salt in their results...)
>
I remember those types as well. Significantly, I work in a research
laboratory with six physicians under 40 years of age. Of those 6, five,
that I know of, were NOT premedical students and three had no plans to
enter medical school at the time of their baccalaureate. Also, while
national statistics still show that a large percentage of medical students
were trained in a pre-professional program, that percentage has consistently
declined over the last 10 years. In fact, in a recently completed 
comprehensive study on the Graduate Professional Education of the Physician
(GPEP), the Association of American Medical Colleges (which represents
greater than 95% of all U.S. medical schools), recommended the elimination
of the pre-prefessional undergraduate curriculum in favor of encouraging
students to pursue their individual programs of study in the fields of
their choice. For interested parties, the full text of the report of
this group (which sets the standards for medical education in the United
States), can be obtained from the Association of American Medical Colleges
(AAMC), Dupont Circle, Washington, D.C. (ask for the GPEP report).

>What brought this on:  We recently received a bill from a hospital for $7700+
>for a 7 week stay for my Great Aunt (92 yrs. old).  The Doctors at the
>hospital performed every test they could, just to build up a bill.

This has been answered by other respondants but as stated, it is unlikely
that this is true. There are many reasons why a large number of tests may
be ordered on a patient ranging from the need to make a diagnosis to the
need to protect oneself from medical malpractice. In fact, as a socio-
economic phenomenon goes, the contribution to cost of health care from
legal arbitration has been astronomical and totally disproportionate
to the damage done by a subgroup of incompetant physicians. It IS
true that medicine, like any other fields, has its share of incompetants
who do real harm to their patients. But unlike the guy who designs your
Ford Pinto or your DC-10 airplane, the modern physician practices his
trade with almost as much doubt and uncertainty as physicians from
past ages. We simply do not know enough about disease to say which
people are going to get what disease and how badly will they be affected.
With time, the good physician is able to get a better "feel" for the
behavior of a certain disease within the population but no one who is
honest with their patients can, in most cases, guarantee specific
results. This is something which most of us fail to understand and,
as a result, we are sometimes surprised and disappointed by an outcome
we did not fully expect, even if it was good. Still, because we can
find a court who can sympathize with the disorientation and the
uncertainty that we face (as patients), we can usually be rewarded
(at the expense of insurance payments and additional tests for other
patients).

On the other side of the coin (and interestingly), I heard a comment
from a veteran physician once; he said "I never saw a physician sued
who talked to his(her) patients." So to a certain degree, malpractice
stems from dissatisfaction with the patient-physician interaction,
rather than (necessarily), the quality of medical care given.

>They requested permission for an "exploratory operation" to remove
>fibers from her bladder. Were the fibers likely to be dangerous?  
>"No ... " responded the Doctor.

Case in point. It is possible that this was exactly the case, although
I have never seen a physician quite as blatant about it. More likely,
the physician simply lacked the ability to sense your uncertainty and
discomfort, and missed the opportunity to DISCUSS the procedure in
question. Although unnecesary surgery and medical treatment is still
performed in this country (a recent study suggested 1 in 9 operations
would NOT have been done if a second opinion had been obtained), what
is more common is that necessary diagnostic and/or therapeutic measures
are not adequately explained to the patient/family before the procedure
is done. In fact, new laws regulating medical care payments have resulted
in the establishment of hospital-based patient care and utilization
review committees which help to control the cost and length of hospital
stay. In our hospital, for example, the physician (and the hospital), is
NOT re-embursed for the expenses of a patient whose treatment/hospital
stay goes beyond the limits imposed by the utilization review process.
This process is binding and has been effective in reducing the cost of
some hospital stays.

>Quite annoying.  Who pays for all this?  We all do (my GA was on Medicaid),
>either through taxes or higher insurance rates.

Your physicians taxes pay for it to. And I don't mean to say that physicians
who admit the patient and order the tests have NO control over the cost of
the stay, but believe me, most of that money goes to pay for operation of
the hospital and NOT into the pocket of the physician. And don't forget
that most significant diseases in the U.S (in terms of the overall health
of the population and the COST to the public), are death and injury related
to accidents, cardiovascular disease, and cancer. Automobile accidents
(which is one of the big categories in addition to fires and home injury),
have been linked to speeding and drinking in almost 80% of the cases. The
cost of services to support and care for the victims of automobile related
injury are astronomical and this is injury could be almost totally eliminated
by a responsible population. Cardiovascular disease, including high blood
pressure, stroke, athersclerosis, have a strong association with diet,
exercise, smoking, and job-related pressures, something which the medical
profession has tried to do a great deal about in terms of informing the
population. In spite of this people continue to smoke, and your tax dollars
go to support the tobacco growers, as well, even if YOU don't smoke. The
population is given advice about exercise and diet, and how many people
follow it (in what other situation would you pay money for the opinion
of someone you intended to ignore, yet that's what people do with medical
advice). And cancer, I would point to environmental pollution and
cigarettes as known causes of cancer injury and death. We all pay to
support these, as well. So you see, the public has a much heavier hand
in how its money is spent than you might think.

>By the way, they never asked before performing many of the tests, 
>they just did them.

In most cases, the consent form that the patient signs on admission to
the hospital grants consent for the performance of most of the "routine"
hospital tests that are performed. In our hospitals, certain additional
tests, while not common, are routine in certain cases and do not require
separate consent. In all other cases, we routinely obtain separate written
consent for additional procedures/tests which care a higher risk or which
might compromise patient comfort. The patient is free to refuse consent
for any and all tests, and can even withdraw signed consent at some later
time if he/she so desires. This is the law. If it was done, otherwise,
in the case of your Great Aunt, this is not standard practice.

Finally, I might note that many of us with the health professions share
the author's concern about the cost of medical care in the U.S. and, in
fact, this issue has reach the national agenda. But the solution of the
problem lies in attempting to understand, but not oversimplify the issues.
There are greedy people in medicine (like any other field), but these
people represent only a small portion of the entire profession which
includes many people concerned with the same things that you are, and
who are working to control these costs without compromising patient
care and/or health.

Sean McLinden
Decision Systems Laboratory
University of Pittsburgh
School of Medicine