Tuesday, November 25, 2014

NYT: How Medical Care Is Being Corrupted

I was pleasantly surprised to see this OpEd in the 11/18/2014 New York Times by Hartzband and Groopman, "How Medical Care Is Being Corrupted".

In particular, they describe perverse incentives being imposed upon physicians to practice "cookbook medicine", often at the expense of actual patient care.

An excerpt:
Contracts for medical care that incorporate “pay for performance” direct physicians to meet strict metrics for testing and treatment. These metrics are population-based and generic, and do not take into account the individual characteristics and preferences of the patient or differing expert opinions on optimal practice.

For example, doctors are rewarded for keeping their patients’ cholesterol and blood pressure below certain target levels. For some patients, this is good medicine, but for others the benefits may not outweigh the risks. Treatment with drugs such as statins can cause significant side effects, including muscle pain and increased risk of diabetes. Blood-pressure therapy to meet an imposed target may lead to increased falls and fractures in older patients...

When a patient asks “Is this treatment right for me?” the doctor faces a potential moral dilemma. How should he answer if the response is to his personal detriment? Some health policy experts suggest that there is no moral dilemma. They argue that it is obsolete for the doctor to approach each patient strictly as an individual; medical decisions should be made on the basis of what is best for the population as a whole.
We fear this approach can dangerously lead to “moral licensing” — the physician is able to rationalize forcing or withholding treatment, regardless of clinical judgment or patient preference, as acceptable for the good of the population.
As always, a key principle is, "follow the money".  When the government (or insurers acting as proxies for the government) control the medical pursestrings, they'll also control medical care.  Which may or may not be the care that's right for you as a patient.