Physician, Heal Thyself (or at least do it more cheaply)

There’s a real lack of understanding in this country of the extent of the problem of medical waste and what I guess you’d have to call doctors’ incompetence. Uwe Reinhardt has a great post laying much of this out including the striking fact that “on average, American patients receive the recommended treatment for their condition only slightly more than 50 percent of the time.”

The structure of Medicare allows us to do pretty solid apples-to-apples comparisons of what different hospitals are spending on treatment, and the evidence is clear that the hospital-to-hospital variance is costs is large, and in quality is also pretty big, but the differences seem uncorrelated:

According to the Dartmouth researchers, if physicians with relatively higher cost preferred practice styles could be induced to embrace the preferred practice styles of their equally effective but lower-cost colleagues, overall per-capita Medicare spending probably could be reduced by at least 30 percent without harming patients, and similarly for commercially insured younger Americans. How can a nation that routinely wails over its high cost of health care ignore such important research?

I’ve been watching a lot of House re-runs lately, and they’re a striking encapsulation of part of what’s wrong with the way Americans think about medicine. Dr House is unfailingly portrayed as a bad person but a fantastic doctor and the medical ideal is seen to be that of the brilliant explorer-hero who does what it takes to solve the most difficult cases. An alternative model would see the doctor as a kind of custodian of public health. A general practitioner who develops an effective method of nudging people toward quitting smoking or exercising more during his brief post-checkup chats would save many more lives at dramatically lower cost than would all of Dr House’s heroics.


And of course most doctors in the real world aren’t like genius television characters — unleash them from concerns about cost-efficacy and imbue them with a heroic self-conception and they don’t even give you costly-but-effective medicine. Almost half the time they don’t even do the right treatment.