Wednesday, March 31, 2010

Why Medical Care Costs So Much


The cost of medical care is high because the body is complicated and doctors and patients hate ambiguity. The cost is high because a missed diagnosis can lead to death and a large lawsuit. The cost is high because we have many specialists that view the body in tiny pieces and want to feel 100% correct about their piece. Let me give you a real life example:

My patient, Rick is a brilliant attorney. He has insulin dependent diabetes and heart disease and he takes good care of his health. He pointed out that his lower leg (around his shin) was red and swelling and then forming a painless hard lump. The exam showed a little redness, a tiny puffiness and a small firm lump in his leg tissue. I ordered some blood tests to make sure his diabetes was under control and to look for infection. Because I couldn't put a name on it and I was unwilling to say "Let's watch it, I don't think it is anything serious", I told him to ask his dermatologist , who he was seeing anyway. The Dermatologist said it wasn't in the skin, it was deeper so he was referred to an orthopedic specialist. The Ortho doctor said he wasn't sure and did an Xray. Since the bone was fine he ordered an MRI. The MRI showed no tumor, no vascular problem.

After several months of doctor's visits and spending $2,626.40, we have no diagnosis and I realize I should have said "Lets watch it, I don't think it is anything serious."

Rick has high deductible health insurance. He pays $4,800 annually out of pocket before insurance kicks in. He usually hits his deductible because of the diabetes medication and tests.

None of his doctors own imaging centers or labs. We don't make any money on ordering tests. We all wanted to help the patient in the only way we were trained to do.

I asked him if he would have been satisfied with me saying "Let's watch it, I don't think it is anything serious" after that first visit. He said, "Yes, I trust you". But he still has a leg that is swelling and a lump that forms daily. The symptoms are mild but strange.

Now we will watch it and it will probably go away and we'll never know what it was. That happens more often than not. We can all rest better knowing it is not serious but achieving our collective "peace of mind" is one reason medical costs are so high.

12 comments:

Anonymous said...

What a story. It certainly shows the difficult thought process of physicians in trying to figure things out. Thanks again for a great and thought provoking post.

Michael Kirsch, M.D. said...

I still have the 1986 classic article from The New England Journal of Medicine on the medical cascade you describe. Here's the citation, but without the full text available. This should be required reading for all physicians-in-training, as well as the rest of us. http://content.nejm.org/cgi/content/citation/314/8/512

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linkwheel said...

I still have the 1986 classic article from The New England Journal of Medicine on the medical cascade you describe. Here's the citation, but without the full text available. This should be required reading for all physicians-in-training, as well as the rest of us

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