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May 14, 2015

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anon

Couldn't disagree more.

The forbearance wasn't an accident: that is the reason you went to a specialist. The workup was necessary because there were possible conditions that MIGHT have required attention, and you likely would be the first to complain if the doc hadn't done the workup. It was only a "waste" because nothing was discovered. Your logic is faulty here.

What you should be complaining about is not that you, as a privileged member of society, received adequate (not excessive) health care.

What you should complain about, first, is the ridiculous charge for the MRI (this should have been about 1,800 : you probably had it done in a hospital or facility recommended by a doc with a financial interest). Even 1,800 is a phony charge: many insurers authorize far less. MRIs have been a money making scam for years. Go after that, Steve.

Second, it is posts and attitudes like this that is leading the medical establishment to decide, as the baby boomers hit the expenditure phase, that the way to cut medical costs is to deny medical care. Sure, a hundred tests might reveal only one positive: and, the loss of that one person isn't such a big deal, right? Cut screening. Wow, that is beyond faulty logic, it is sinister, and in my view, quite evil. The way to cut medical costs is to go after big pharma and medical device costs, not to allow people to die because "screening" costs too much (a false and pernicious argument).

Third, your personal story is sort of irrelevant to these bigger issues. Anecdotal "evidence" is what leads so many to make such bad policy decisions.

Please, study the issues and get some facts on these issues.

And, needless to say perhaps, I share you sense of relief that the tests did not reveal a major issue. I'm sure you recognize how fortunate you were to have had those tests.

SL

It's only an anecdote, so I won't ask you to read it again, Anon, but my complaint was about ordering the MRI, in the first place, not the subsequent trip to the specialist for advice about it.

anon

Yes, I reread it.

Sure enough, you went to a hospital for an MRI, and now, you are complaining about the cost. So much for a "responsible consumer."

If you cared about the cost, you should have gone to a free standing MRI facility, where your MRI would have cost less than 50% of what was charged, perhaps even less. You just didn't do your homework, and now you are complaining about the cost.

Why not do the research to discover the reason that hospitals charge two or three times what others do for the same scans on the same equipment? Or, better yet, why didn't you learn about this simple (but well known fact) before now complaining about your poor choice of facilities (if you were concerned about cost)?

Second, you say "I got a phone call from Dr. K’s nurse. “There was an area of ‘sclerotic focus’ on your X-ray,” said the nurse, “and Dr. K wants you to do an MRI.” “What is a sclerotic focus?” I asked. “It could be a bone spur, or maybe it’s just occluded,” she said, adding, “and Dr. K also wants to know when you had your last prostate exam.”"

Here again, you are just complaining about your own understanding (or misunderstanding) of what was said. Nothing about what your specialist told you contradicted what the nurse told you. And, she didn't say the MRI was ordered to evaluate the prostate: she wanted to know when you had your last prostate exam: a reasonable inquiry given your complaint and age, etc.

You say the MRI was unnecessary. But again, you quite obviously don't know whether it was necessary or not. You saw one specialist who had a conservative and dismissive attitude. You obviously don't have the medical training to know whether it was the standard of care to order the MRI (your post reveals no understanding of any these issues). ANd, one senses you would be first one to complain if, after receiving that x ray, the doc hadn't followed up and something that would have discovered as a result was not.

Finally, it is rich that you say I didn't read your post when you so obviously didn't read my comment. I would say you should read my comment. Your little story has nothing to do with the macro issues you have identified in your post, other than to confuse readers with extraneous and irrelevant information. I consider this sort of claptrap risky, because these sorts of ill informed opinions catch on, and many people will suffer if that is the case.

anon

Addendum

The quote from the NYT: "“The medical system had done what it so often does: performed tests, unnecessarily, to reveal problems that aren’t quite problems, to then be fixed, unnecessarily, at great expense and no little risk.”

This has zero to do with your story. Absolutely nothing.

Tee

Great piece and excellent points. I've been down this rabbit hole and recognize that inexorable path. As you say, it is a very difficult, exhausting and expensive conundrum. For people without adequate healthcare coverage it can indeed be catastrophic even when it turns out that it wasn't.

Dana Lubet

I am a little surprised that your letter was greeted with such vitriol from Aaron, who ever that is. I am equally surprised that no one mentioned the CYA aspect of testing which is often complained about by health care providers and patients alike.

Dana Lubet, DDS

anon

Tee sheds a tear for those "without adequate healthcare coverage"? One wonders: do you approve of a "reform" plan that encourages folks to buy "health insurance" with a 5K deductible, knowing full well that the majority of people don't have that much to pay?

Do you support the illogical conclusion that it is appropriate to rely in any sense on a personal anecdote (that demonstrates nothing of substance, and much misunderstanding) in order to blame life saving tests for the waste in the medical system? Have you been informed about the cost of relying on such nonsense in real lives? Who cares, right? Why not tell a little story and ask readers to draw a conclusion from it?

What is worthy of some modicum of outrage here is that so many people rely on "stories" like this one while simultaneously supporting the frittering away of billions and billions to provide profits to private health insurers by way of premium subsidies, the making of secret deals with Big Pharma and the paying untold billions because of inequitable pricing that takes advantage of the "responsible consumers" like the one who posted above (who aren't aware, for example, that hospitals charge double or triple for MRIs).

Yet, why object to a blog post that decries efforts by physicians to forestall more serious conditions? Because such nonsense leaves in the minds of too many the casual and inaccurate notion that unnecessary testing is the reason the medical system wastes so much money.

The poster above does not seem to know or care about the standard of care. Dana Lubet doesn't say that the standard of care was to ignore the radiology report and to not recommend an MRI. This whole "story" is a tale told to make a point: a point that this reader considers inaccurate and pernicious.

Does Dana Lubet also advocate cutting testing, such a mammograms, PSA testing, etc. against the recommendations of nearly every medical organization, as do the proponents of the nonsense suggested by the post above (i.e., that the "waste" in the medical system is associated with unnecessary tests and "defensive" medicine)?

Worse, Dana comments on the "CYA" aspects of medical waste. This is an old canard. Have you the stats on the costs of medical errors? Why not turn your attention to those issues?

Instead, we have the citing of the reasonable responses by medical practitioners to the original poster's complaints, for which the original poster should be grateful. Instead, such efforts are portrayed unfairly as evidence of "waste."

Why not look at the problem thru a more informed lens? Instead of taking a cheap shot at this commenter, and complaining about tone, why not address the real issues?

Diff-Anon

Very interesting post. Glad everything turned out ok for you. My view is that your MRI is a very good example of what Dr. Gawande was talking about.

Most hoofbeats turn out to be horses, not zebras, but there are a lot of competing pressures and factors that go into whether and when to pursue, at considerable expense, the possibility of a zebra.

Screening exams (mammograms, PSA, PAP, etc) are different in some respects from diagnostics when hoof-beats are heard, of course, but they do raise the same basic issue about effective use of inherently limited healthcare dollars. I notice that we are starting to get more sophisticated about the cost-effectiveness of these exams -- and adjusting recommendations accordingly. The recommendations for frequency of PAP smears have changed since I was in my 20s, for instance. The recommendations for colonoscopies seem to be more nuanced than they were ten years ago.

We remain stymied by the challenge of figuring out when to pursue the possible zebra. It's frustrating, if you care about the healthcare finance system, when you hear anecdotes about very fancy workups for bursitis. But it's horrifying to know people whose very serious conditions were missed, or missed until it was too late, because a horse was assumed and the more expensive testing deemed cost-ineffective.

Thanks for your post. I think the comments prove it an interesting and worthwhile topic.

anon

Diff Anon

At last, some discussion that refers to the actual problem, and the solutions being developed to address it.

There is deep disagreement about the testing protocols. But, at least docs have some standard by which they can measure their conduct: a standard of care addresses both the "waste" and "CYS" problems.

THis was the fundamental problem with the original post. The author didn't know what the standard of care was, didn't realize the he was "wasting" double what the MRI could have cost, and ignored the gouging that obscures what it SHOULD have cost. In other words, the original post had not much to do with the stated issues.

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