Understanding treatment costs, a ‘disobedient doctor,’ and the aid-in-dying law

May 26, 2016

In order to bring you more of the news you want to read, RightCare Weekly summarizes and interprets three important articles and provides headlines linking to the many other articles and editorials you’ll find interesting. As always, RightCare Weekly presents articles related to moving our healthcare system toward the right care for all patients.

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Physicians are often blamed for overuse of medical tests. After all, they wield the pen, or increasingly these days, they do the clicking of ordering boxes. New research from the Dartmouth Institute for Health Policy and Clinical Practice sheds light on physicians’ understanding of tests and treatment costs. The group’s study aimed to test doctors’ awareness and knowledge of Choosing Wisely, the American Board of Internal Medicine Foundation campaign that helps physicians identify low-value services. The survey of clinicians at a large outpatient care provider in Massachusetts found that while nearly all the respondents agreed they should reduce the number of unnecessary tests, only 36.9 percent said they had an understanding of test and procedure costs to the health care system. According to a story in CommonHealth (WBUR), primary care doctors were more likely to report feeling pressure from patients to order tests that were not necessary. More this week on unnecessary tests: A New York Times article questions why men are still being over-tested for prostate cancer, given the 2012 U.S. Preventive Services Task Force recommendation against all routine PSA testing, regardless of age. The article includes study findings from two years ago indicating that a majority of patient respondents, age 75 or older, who had a PSA, said their physicians had recommended it. Only half the men remembered that their physicians explained advantages for the test; only a quarter recalled being told about any of the risks.

Last month, young physicians in the United Kingdom opted to strike over working conditions and pay cuts. One complaint, in particular, the loss of autonomy, may resonate with U.S. physicians. This week in Medscape, Howard Waitzkin, MD, confesses to being “a disobedient doctor,” at his rural health program. Angered by mounting administrative demands, Waitzkin finally drew the line at a time-consuming employer-required course on the ICD-10. Waitzkin, an internist, refused to comply after finding the training encouraged “up-coding.” He was threatened with suspension after he asked for evidence that the training improved patient outcomes or cut costs. “I must behave like an automaton in a medical assembly line,” he writes. His disobedience eventually led to a face-to-face meeting with an administrator, who retracted the threat and agreed to consider individual physician training preferences in the future. “For a person like me,” he writes, “closer to the end of my medical career than the beginning, such acts don’t risk much. For others, overcoming the risk will require a more organized approach to disobedience.” Waitzkin asks: “Dare I encourage disobedience in unison?” He has found one answer in the Right Care Alliance, which he joined last week. Welcome!

Kristy Allan, 63, is dying from colon cancer, and in an inspiring essay in The Mercury News, she explains her end-of-life choice, given California’s aid-in-dying law, which goes into effect in two weeks. Fearing her inevitable decline and sensitive that her family will bear witness to it, she has thought long and hard about taking prescribed medication to end her life when she’s ready, and writes that she’s thankful that she can do it. “Just knowing I can obtain a prescription for aid-in-dying medication that I could ingest if my suffering becomes unbearable is absolutely comforting,” she writes. Eric Snoey, MD, who supports the California law, writes in the LA Times, that while the law’s nuances can sometimes be tough for patients and physicians to navigate, physicians need to remember “that the end point of medical innovation and intervention isn’t immortality.”


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