There is considerable evidence that many of the new medical technologies are used inappropriately, to generate income. What patient protections against inappropriate diagnostic and other procedures should be considered?
There is no doubt that the new diagnostic and therapeutic technology now available has vastly expanded the economic dimensions of medicine, there is evidence that new and expensive technologies are being used inappropriately to generate income. One example of this statement would be the use of magnetic resonance imaging or MRIs. The popularity of this testing has skyrocketed and has in turn been found to be very profitable for hospitals and outpatient facilities. Despite the swooping popularity and booming financial boost this testing has been found not to have changed patient outcomes. The testing gives providers a clear look at the disease or anatomy being scanned there are no controlled comparisons of diagnostic accuracy or changes in medical or therapeutic care for patients (Sultz and Young, 2011). Therefore this new and innovative testing only adds to the cost of the already terribly high dollar of health care.
Physicians now have many choices to make and many opportunities to generate income through the use of these and many more new technologies both in the office and hospital settings. The issue is that medical indications for the use of much of the new technology are not precisely causing problems and susceptible influence by economic factors. The range of acceptable options in a given case is often wide enough to give the provider considerable latitude in his/her choice of procedures. It is in this gray zone that economic incentives have their greatest effect on medical behavior (Relman, 2011). I do not believe that providers make decisions based on economic consideration and outcome that they would not decide otherwise. I believe with all of my heart that for the most part providers do things the majority of the time to do right by the patient and the pocketbook. The problem is, however, “the right thing” is often a matter of opinion because many tests, procedures, and operations have not yet been fully evaluated or scientifically compared with other available measures for cost effectiveness.
Is it possible though pressure of financial advantage often sways those good-hearted providers or is it simply to pacify or satisfy patients? To expand on pacification or satisfaction or patients I will use my area of expertise. I have worked in the area of women’s health most of my career so though I am sure there are other areas of specialty with patients such as ours I can only state from true experience that this is a very high-maintained population. This is a media savvy, device driven; patient population that often wants “drive-thru” service. The issues I see to often are the ordering of tests, labs, procedures that may be unnecessary or cause greater consequence. There are high-technology screenings for every atypical cell we could possibly have on a female reproductive organ. As soon as a pre-menopausal women with heavy bleeding hears that she may have a positive result she wants a hysterectomy. Though this may be the treatment for some, it is not for all and I see way too many women loose their uterus for reasons that were much more benign than the outcome.
Being in healthcare for so many years I could give example after example of new high technology that may be used inappropriately for reasons that could be generating income, but done simply for the benefit of the patient and their satisfaction. Patient satisfaction brings a whole new topic of conversation to generating income. So how can we protect patients from potentially themselves or those that provide the ordering power that initiates this vicious cycle? I think first we have to mandate facilities and practices to put in place guidelines and protocols to stop unnecessary testing that has been shown not to change the patient outcome. Another intervention and protection to patients is that providers have to have conversations with patients honestly about what the issue is and that they do not need particular testing if asked for.
They need to keep it real with patients. It is true that patient satisfaction is going to be at jeopardy and that they may want to jump providers, but providers and facilities will need to seriously look at the risk benefit of doing procedures that will not weigh up in a court of law or a court of public opinion. In spite of nursing’s vital importance to hospitals, nurses face excessive paperwork, managerial responsibilities, and supervision of lesser-trained aides — tasks that require an inordinate amount of time spent in functions other than direct patient care. These frustrations, combined with long work hours, stagnant salaries, and other difficulties, have resulted in fewer entrants to schools of nursing and increasing numbers of nurses leaving the profession. Discuss possible solutions to this growing problem.
Do providers in the health care system recognize a broader social mission than addressing the needs of only those individuals who achieve access to their services? Elaborate.
Relman, A. (2011). Cost control, doctors’ ethics, and patient care. Retrieved from http://www.issues.org/19.4/updated/relman.pdf.