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How Sprained Ankles Can Lead To Cancer Drug Rationing

New York Times blogger Tara Parker Pope describes how her daughter was recently “the victim” of excessive medical investigation. Apparently, the little girl twisted her ankle at dance camp and experienced a slower than normal recovery. Four weeks out from the sprain, Tara sought the help of a specialist rather than returning to her pediatrician. The resulting MRI led to blood testing, which led to more testing, and more specialist input, etc. until the costs had spiraled out of control – not that Tara cared much because (as she admits) “I had lost track because it was all covered by insurance.”

Instead of any twinge of guilt on the part of Ms. Pope for having single-handedly called in the cavalry for an ankle sprain, she concluded that her daughter was a victim of medical over-investigation. But what would any physician do in the face of a concerned pseudo-celebrity parent (with a huge platform from which to complain about her medical treatment)? The doctor would leave no stone unturned, so as to protect herself from accusations of “missing a diagnosis” or being insufficiently concerned about the ankle sprain.

The responses to Ms. Pope’s personal “horror story” about over-treatment (and the waste of billions of dollars inherent in the US medical system) were amusing. One commenter writes, “Why not think of the unnecessary $210 billion as a fiscal ‘stimulus?’ Makes as much sense as any other program in the Age of Obama/Krugman.” And another, “[Of course there's over-treatment] because the federal government subsidizes it! Medicaid, Medicare, and third party private insurance all promote the use of wasteful health care spending. And Obamacare will put that process on steroids.”

Whether or not you agree that socialized medicine reduces healthcare costs, it seems to me that we all have a responsibility not to over-utilize medical resources so that they will still be there when we really need them. Over-investigating every pediatric ankle sprain will simply drain our collective resources, ultimately resulting in further healthcare rationing. New York Times writer Peter Singer has argued that rationing is inevitable and decisions about cancer drug treatment will become the purview of US government agencies as time goes on. I’m pretty sure he’s right.

That being the case, why spur on rationing? Ms. Pope’s victim mentality demonstrates her lack of insight into the true causes of rising healthcare costs – one of which is patient demand. Ms. Pope herself is contributing to the healthcare waste she despises by requesting excessive testing in an environment where physicians are afraid to say no due to legal pressures (or a NYT writer’s bully pulpit). Demand drives costs, and there is a finite limit on our resources. Personal responsibility must play a role in healthcare utilization, just as efforts to protect our environment and scarce resources require participation by individuals. Ultimately, one child’s ankle investigation comes at the price of another patient’s cancer treatment.

Was it the physicians’ responsibility to put the brakes on her daughter’s over-testing? Maybe, but I’d prefer to live in a world where patients can invoke additional testing when their personal judgment suggests that it’s important. Ms. Pope knew better, but requested the additional testing because her insurance paid for it. Free care leads to more care – especially more unnecessary care. Ms. Pope’s daughter was not a victim of over-testing, but a beneficiary of that luxury that may soon evaporate.

We can create a healthcare system where no ankle gets more than a physical exam and ibuprofen (so we can forcibly prevent over-utilization), or we can teach people to use healthcare resources responsibly. Unfortunately, that will require that patients have a little more financial skin in the game – as Ms. Pope has demonstrated. The alternative, a distant oversight body regulating what you can and can’t have access to in healthcare, is where we’ll probably end up. Some day in the future Ms. Pope will recall the day when she was able to get unlimited medical investigations for her daughter without question or cost, and she’ll marvel at how that freedom has been lost. By that time, I suppose, I’ll be one of those people who is being denied cancer treatment by my government.

Will We Ever See Accountability And Transparency In Our Healthcare System?

President Obama, where is your promise about transparency and accountability in Obamacare?

A major problem in the healthcare system is the lack of transparency and accountability. It has been unchecked for a very long time.

Both primary and secondary stakeholders act in their self-interest. These stakeholders have had ample opportunity to be non-transparent and non-accountable. All the stakeholders have abused the healthcare system.

I hit a nerve with my last blog “Patients And Physicians Must Control Costs”. Multiple readers responded with the usual comments:

Patients are not smart enough to handle their own healthcare dollars.”

“Your basic idea makes sense, but in reality I doubt that a patient knows enough to make intelligent medical/financial decisions, because there are too many unknowns and variables.”

“Physicians over use the fee for service system in order to make more money.”

“If a physician tells a patient that there is only a 1/10,000 chance that an MRI will yield something useful, if the patient doesn’t have to pay for it, the patient wants the MRI.

Patients (consumers) must be taught and motivated to manage their own healthcare dollars. Patients’ choice Read more »

*This blog post was originally published at Repairing the Healthcare System*

British Government Denies Coverage Of Less Toxic New Drug (Dronedarone) To Heart Patients

As has been pointed out (pointedly) to DrRich, we do not have death panels in the United States. And indeed, considering that we’re not conducting military tribunals for Islamist terrorists who have tried  (or succeeded in)  killing and maiming as many of us as possible, it seems relatively unlikely that we’d assemble death panels (which sound even less due-process-friendly than military tribunals) for American patients.

What we will have, however, is a federally-mandated assembly, body, committee, commission, board, diet, parliament, or posse (but not a panel) of experts which will carefully evaluate all the objective clinical evidence regarding a particular medical treatment, and make “recommendations” to doctors about whether or when to use that treatment. The model which frequently has been offered up for our consideration, as we contemplate the workings of such a non-death-panel, is the British National Institute for Clinical Excellence, or NICE. Read more »

*This blog post was originally published at The Covert Rationing Blog*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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