Doctors in the Crosshairs

We’re in trouble.

No, really. We’re in a lot of trouble.

We’re an aging population. Health care consumes an increasing amount of our budget. And we’re undermining our strongest allies.

I became a physician in the HMO era and was encouraged to minimize the tests I ordered and specialists I consulted. The consequence was that some patients didn’t receive prompt care. One young man, treated for cancer a year earlier, yelled at me when I explained that his referral to an oncologist would require three weeks. While I hadn’t selected his insurance plan, I understood his frustration. When I suggested he pay out of pocket to see the oncologist he already knew and trusted, he angrily left my office.

“Patient-centered care” is now in vogue. I believe strongly that the patient’s wishes must be central to any evaluation and treatment plan. But a twisted version of this concept is encouraging dangerous behaviors. Health care organizations, eager to ensure their doctors are the best, rely on patient satisfaction scores to assess quality and pressure doctors to generate high scores. If patients want an MRI, even if it won’t provide relevant information, or if they want a particular medication, even if it won’t help, physicians are afraid to say no, lest patients give them a bad rating. With online ratings, patients can mar a good doctor’s reputation if the doctor falls short of a patient’s expectation, such as refusing to fill out a disability form if the patient isn’t disabled. Doctors find themselves caught between their ethics and the chance of being fired or having their reputation smeared by an unhappy patient.

As expensive technologies become commonplace and our aging population requires more care, insurers have reduced payments to doctors. To maintain revenue, healthcare organizations ask doctors to see —> Read More