Something not in the article is the impact of shows like Grey's Anatomy, The Doctors, Dr. Oz etc. A Patient walks in demanding to see a physician with 20+ years experience, does not get the answer he or she wants, then demands tests. Why do the doctors prescribe the tests? One, they get paid to do the testing, even if they know going in that the the tests are not at all needed, and may in fact cause harm. This is all noted in the charts, billed at the standard rates and the machine grinds along.

The second, not mentioned in the article, is litigation. Yea, it is the defacto nonsense boogeyman to jump onto lawyers, but hear me out. Lawyers are not the problem, mostly. Patients are; and it is only very marginally their fault. Malpractice insurance is as high as 2/3 of a surgeon's yearly income, and one of the reasons for that is that a patient who wants to second guess a physician can find an attorney to write a letter. I am not even talking lawsuit here, it is not uncommon for a patient to get an attorney to manage their care knowing going into the arrangement that there will not be a "big cash settlement" like you see on the TV commercials. Doctors hate getting those letters and I've seen MDs fire patients and send them away if there is a fear that they are going to lawyer up and use that to second guess every care decision. Fortunately I've not see this where I work, but I watched an old GP fire a whole family while I was waiting in my room a few years back. Doctors all know that it is easier to make the patient happy than to do depositions and waste billable office time with court appearances. So the docs waste the systems resources with stuff that is not needed to make the patient happy and hopefully make the lawyers go away to prevent malpractice points on their record.

In some fields of medicine, the docs will work with the legal people more than the actual patient because they know that making the lawyer happy is more important economically than making the patient healthy. Nobody running for president will talk about this aspect of health care as most of them are lawyers and only see the system through that lens.

Single payer systems won't fix this either. I'd love to say better access to information will help, but all that does is give quacks like Dr. Phill and Dr. Oz and the TV garbage sway over very personal health care choices. The article nailed it, IMO:

One major problem is what economists call information asymmetry. In 1963, Kenneth Arrow, who went on to win the Nobel Prize in Economics, demonstrated the severe disadvantages that buyers have when they know less about a good than the seller does. His prime example was health care. Doctors generally know more about the value of a given medical treatment than patients, who have little ability to determine the quality of the advice they are getting. Doctors, therefore, are in a powerful position. We can recommend care of little or no value because it enhances our incomes, because it’s our habit, or because we genuinely but incorrectly believe in it, and patients will tend to follow our recommendations.

The doctors spent 10 years in med school, yet everyone second guesses them. And instead of a remediation system that encourages MD's to fix issues as a result of care you end up in court and tons of unneeded expensive exams and studies. This hits the absurd levels when talking to patients more is now being encouraged and MD's are being advised that bedside manner is a hedge against litigation!

As with any big serious issue, there is no simple fix. Patients have to be better, docs have to be better, insurance (of all kinds) needs to realize that the doctor should have the final say in whether a procedure is needed, and yes, lawyers need to work with docs to advance the care of the patients even if it means fewer lawsuits. And the person who wants to tackle that is going to have to fight the lawyers, doctors, insurance companies and patient advocate groups to even get a voice in the conversation.

whatever the surgeon removed it wasn’t the lump.

Huge fan of Atul Gawande.

Hey might help if you tag it as #medicine