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Friday, October 18, 2002"I was more aware of my bills," DeGoory said. "I looked at the explanation of benefits much more carefully ... and just kept track of where I stood. ... When I had a checkup, my physician said she wanted to run a cholesterol test, and I asked why. When she told me why, I was very comfortable having it." The doctor : "I don't mind if patients consider cost," she said, "but I personally try not to make decisions based on cost. I try not to know anything about anyone's health insurance, so I would have to see how that sort of thing would work out. I would have to have a lot of patients with it first." A lot of physicians feel this way. That’s why therapy of marginal benefit gets touted so much. UPDATE: Here's the perspective of a self-employed, self-insured patient on the issue: Physicians who do not consider costs can create big problems for self-employed patients who purchase their own high-deductable health insurance. On more than one occasion I have payed for expensive tests which, I now realize (and my doctor should have told me) were marginal and probably best avoided. Such gratuitous testing, like traffic tickets that lead to increased insurance rates, can have serious long-term consequences beyond its initial cost. For several years after one of these tests I was flagged by "Have you ever consulted a physician for. . . " questions on health-insurance applications. At least one insurance company subsequently wouldn't cover me, and the one that would cover me required me to take the expensive test again -- to prove that the marginal "condition" that was confirmed by my first taking of the test, and that might have never become an issue had I not taken the test. Needless to say, I am now very careful about which medical tests I submit to. Too many physicians, in my experience, are unconcerned about the costs borne by customers like me who have high deductibles and pay for most tests out-of-pocket. Physicians also tend not to be thoughtful about the costly and misleading paper trails they may be creating via excessive testing. I understand why American physicians order so many tests, but if I as a layman can understand the institutional dynamics of medicine, then perhaps they as physicians can learn to understand better the concerns of atypical patients. My auto mechanic has the sense to know that if I drive an old car he probably shouldn't recommend expensive cosmetic repairs. Is it too much to ask physicians to inquire, before recommending marginal tests, how their patients are paying? At the least, physicians should do a better job of discussing the benefits and costs (including money, privacy, and paper-trail costs in our brave new world of bureaucratized, insurance-driven medicine) of an array of alternatives when they suggest optional tests or treatments. In this regard, I think the frequently encountered "I'm a doctor not a businessman" attitude among physicians does patients a great disservice. Yes, it does do a disservice to our patients. And it's done a disservice to our profession. CORRECTION: One sentence in the above quoted email should read: " At least one insurance company subsequently wouldn't cover me, and the one that would cover me required me to take the expensive test again -- to prove that the marginal "condition" that was confirmed by my first taking of the test, and that might have never become an issue had I not taken the test, hadn't progressed." I inadvertently left out the "hadn't progressed" part. posted by Sydney on 10/18/2002 07:03:00 AM 0 comments 0 Comments: |
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