Comments on Sunday's New York Times article.
Don’t you hate it when you walk out of an examination room with no answers as to when you will feel better, then you stop at the reception desk and sign your life away on the bill?
Sunday's NYT article points out that one of the many places that the healthcare system is broken is the way that doctors are paid. There are financial incentives in the healthcare system to keep people sick. I highly recommend you read the article – your blood pressure might rise, so be sure to have a nice cup of soothing green tea while you are reading it.
Unfortunately, it is not until the end of the article that the author throws a bone to the real problem, a problem that highlights why integrated medicine is the true answer to lowering the costs and fixing our broken healthcare system, especially in the area of incentives.
Conventional medicine is currently based, and has been based for decades, on an Allopathic model.
Allopathic medicine is focused on why a person is sick. It studies dead bodies for answers. It looks at conditions and symptoms in a piecemeal way, addressing each piece separately.
Integrated healthcare is focused on why a person is well. It studies healthy people for answers. It looks at the whole person, seeks root causes, partners with and empowers the patient/client, and prioritizes prevention and maintenance, utilizing Allopathic resources when necessary, but not necessarily as a first choice.
At the end of today’s NYT article, there is an example of a diabetes patient. The doctor is paid to examine the patient’s feet, but not to make sure he exercises.
Doctors might say “well, that’s not my responsibility. I can tell a diabetes patient why exercise is an important factor, but I can’t the patient do it.”
There is no partnership in the Allopathic model. The Integrated model, however, is the opposite. An Integrated health practitioner understands that, ultimately, it is up to the patient to be responsible for being and staying well, however – given our busy world – people could use some help with this huge task. Integrated health practitioners utilize a pedagogical approach with clients – a mentoring, “walk with me” method on a client’s healthcare journey. The client-patient need never go it alone in the Integrated healthcare model, yet will be given the resources to empower her to make healthy decisions on her own when she is ready.
Not so with the Allopathic model. Doctors are expected to know everything and patients nothing. “So what” if the patient has intimate knowledge of her body for her whole life, while the doctor has known her for a 15-minute examination? Americans choose to put doctors on a pedestal, and that has hurt our ability to be a healthy nation.
The article tells us that American doctors are paid way more than other countries, but here in the U.S. we like the idea that there are high paying jobs out there to aspire to, and medicine is such a respectable field that we don’t begrudge the salaries. (My mom was a Flower Child, yet even she has said to me once or twice – why don’t you find a nice doctor and settle down?)
But the article goes on to point out that doctors are paid per task, not salaried. This provides an incentive to do more tasks, i.e. more tests, more examinations, more surgeries, more, more, more.
And to top it all off, they get paid whether or not you get better.
One of my board members has had this important conversation with me frequently (
Ken Goewey). When you take your car into the shop to be fixed, you expect it not to break down again the next day or you’ll demand your money back.
In fact, the healthcare industry is the only industry where people walk in “broken” and – although they hope to get better – they pay their money and say thank you to the medical professionals whether or not their problem has been solved.
Americans would never take that kind of treatment from any other industry. Why do we take it from the healthcare industry?
The article suggests putting doctors on salary. Pay them by diagnosis instead of by task. And if it’s the wrong diagnosis, they don’t get paid. We can pay a doctor so much for appendicitis, a certain amount for ulcers, a certain amount for sinus infections, etc. They can perform however many tests is necessary for the diagnosis and treatment, but they don’t get paid for anything but a recovery of the diagnosed condition.
Of course there would need to be something worked out for chronic and terminal conditions, but generally speaking, the NYT article is correct – we need to have a good hard look at the incentives in the healthcare industry and make serious changes there.
This is not to say that doctors are purposefully performing more tasks so they can make more money. I believe most doctors are in the profession because they truly want to help people. I really want to believe that.
However, I also believe that a doctor is very likely to order/perform all kinds of extra tests and procedures from a basis of “better safe than sorry,” especially when there are no incentives NOT to take those extra steps.
The article does not take so idealistic an approach. It suggests that doctors, when faced with an option of two different tests that could bring back the same results, will choose the more expensive test so as to add more money to the doctor’s pocketbook. The article suggests that doctors will perform unnecessary procedures, because why not? It’ll bring them more money, and the patient wouldn’t know any better anyway.
In fact, Medicare patient procedures have steadily increased over the years compared to HMO patient procedures. The article tells us that Medicare does not like to second-guess doctors, so they rubber stamp doctors’ orders. No wonder Medicare costs are skyrocketing.
I am grateful for the many good doctors who have been in the lives of me and my family, and I completely appreciate the hard work and dedication of medical professionals and research scientists in the Allopathic and pharmaceutical fields. My point is not that doctors and drugs are bad, but that they are not the end-all, be-all of my healthcare, or anyone’s healthcare. They are a component, that’s all.
I compliment the New York Times for bringing healthcare system incentives to public notice, but I certainly wish they’d taken the time to go more in-depth. I believe that if the author kept digging, he would have come to the same conclusion that those of us in Integrated healthcare already know – Allopathic medicine is an option, but not an answer.
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Here is today’s NYT article:
The Nation
Sending Back the Doctor’s Bill
By ALEX BERENSON
Published: July 29, 2007
Fixing the health care system may require a difficult conversation.
http://www.nytimes.com/2007/07/29/weekinreview/29berenson.htmlLabels: allopathic medicine, diagnosis, doctors, healthcare, holistic, integrated, New York Times, treatement, United