Doctors love to feel sorry for themselves when it comes to being held accountable to their patients. The system is so unfair and forces them to do things they don’t want to do. The story below is just the latest example.
I was recently reading a summary of medical news primarily intended for doctors when I came across an interview with a former surgeon general of the United States, Dr. Jerome Adams. The subject of the interview was the high cost of an emergency room visit he recently had in Scottsdale. Dr. Adams had been in Scottsdale for a conference and had decided to hike Camelback mountain. Up and down in two hours and all appeared to have gone well. However, at dinner that evening, he began to feel lightheaded and dizzy and went to the emergency department at the Mayo Clinic.
At the emergency department, Dr. Adams, who is 50 and in good health, underwent a number of tests, received two IV bags of fluid and was discharged with a diagnosis of dehydration. All good so far until about six weeks later when he received a bill for $10,000 for the ER visit. His health insurance plan negotiated the bill down to $5,000, but, due to his large deductible, Dr. Adams had to pay that amount out of his own pocket.
Dr. Adams was pleased with the care he received, but was unhappy with the cost. As he correctly observed, someone should not have to risk financial ruin to get the medical care they need. So what happened here?
As is noted in the interview, about 90% of the time someone like Dr. Adams, an otherwise healthy 50-year-old, presents with dizziness after a mid-day hike, the diagnosis is dehydration and the treatment is fluid replacement. It is that pesky 10% of the time when the cause is something else that mandates the tests Dr. Adams received. As the interviewer, himself an emergency department physician, pointed out, there are a number of other possible explanations for the symptoms Dr. Adams was having that may have nothing to do with dehydration and may indicate the presence of some other dangerous medical condition. The ER doctors had to make sure none of these was present before sending Dr. Adams back out into the world.
Although Dr. Adams agrees that all of the tests he received were appropriate and necessary under his circumstances, in the interview he launches into a lament that doctors order unnecessary tests to cover their butts and to avoid the risk that their medical licenses might be revoked. I have been practicing medical malpractice law for almost 50 years and I have never seen or heard of a doctor losing his or her license for failing to order a test. Dr. Adams lament is just the latest example of doctors telling each other how victimized they are
As many of the commenters to the interview remarked, the high cost of Dr. Adams’ ER visit was more due to corporate ownership of hospitals and the pricing power hospital chains have today than to any other cause. Other causes for high ER bills identified by commenters include the need for hospitals to cover the costs of uninsured patients and the fact that hospitals get paid substantial amounts for all the tests performed in the ER, Some physician commenters observed that this was actually a small bill given the value provided by a fully-staffed ER open 24/7 to care for patients and that, if the doctors were actually in CYA mode, the bill would have been astronomically higher.
The care received by Dr. Adams had nothing to do with the ordering of unnecessary tests to cover the butt of the ER doctor, as Dr. Adams himself admits. But many doctors, and Dr. Adams is a prime example, cannot talk about medical testing without invoking the specter of a medical malpractice claim or a loss of licensure. Both of these things are very rare, but doctors, even when speaking to each other, talk about them as real threats against which they think politicians should protect them. Doctors are not the victims here. More often than not it is the patient who is injured by substandard care and never receives compensation who is the victim.
If I go the the emergency department and there is a 10% chance that I have a significant problem that can be ruled out by a test, I want that test and so should you. The next thing I want is for the doctor not to blame the large bill for my tests on the medical malpractice system, which greatly favors doctors over patients. The real problem here is our broken system of health care delivery, which overcharges and underdelivers.
