Re: The PPACA Thread Part III - Let's have a healthy debate!
Just a small example and may not be typical. 40 years ago if a patient presented to me with headaches, there was an office visit (about $15) at which time i spent time taking a detailed history asking pertinent questions for the patient to give me a complete description of how it presented, what it felt like, when it occurred, who else in the family had them, etc. and did a complete head and neck physical exam. if i found nothing to indicate anything more severe, they got some pain medication(probable cost for some low dose codeine $5) and some instructions as to what to watch out for and were sent home and asked to call me the next day. Then and only then, if they have not responded, perhaps a reexamination was done or some further testing ordered.
In today's medical world, same patient, gets seen for an office visit of $150 but fills out a questionnaire instead of talking with the doctor for any length of time, a cursory physical exam(but is weighed and measured and other vital signs taken to insure payment as a higher level visit by the insurer or medicare). They are sent for a CT Scan and perhaps almost assuredly an MRI and maybe even to an ENT man for sinus films. Other tests may be ordered including a general series of blood screenings(cannot even overlook those obscure remote possible related problems). They are given an Rx for some non steroidal antiinflammatory(which most likely will not work as well as the codeine would have but certainly costs far more and upsets their GI tract more). With all the controls now in place and the fear that any opioid will lead to some kid somewhere taking it, selling it or OD'ing on it. After all this exhausting testing the patient has had the million dollar work up. The doctor feels a bit better protected that he did not miss something serious(which his medical acumen should have told him anyway) but is really no less safer from legal action since anyone can sue for anything. Perhaps the patient was talked to abruptly by the young lady at the front desk, or felt they were kept waiting too long, or found out some other test could have been done(maybe not even SHOULD have been done, just COULD have been done). Total cost beyond calculation. And most often, no clear diagnosis is made so the patient goes off to see someone else who repeats everything again and adds a few more tests because they always have to find something. Welcome to the world of medicine in 2015.
Of course much of this is being facetious and i don't really believe that all testing is not of some value, but this happens all too often.
Just a small example and may not be typical. 40 years ago if a patient presented to me with headaches, there was an office visit (about $15) at which time i spent time taking a detailed history asking pertinent questions for the patient to give me a complete description of how it presented, what it felt like, when it occurred, who else in the family had them, etc. and did a complete head and neck physical exam. if i found nothing to indicate anything more severe, they got some pain medication(probable cost for some low dose codeine $5) and some instructions as to what to watch out for and were sent home and asked to call me the next day. Then and only then, if they have not responded, perhaps a reexamination was done or some further testing ordered.
In today's medical world, same patient, gets seen for an office visit of $150 but fills out a questionnaire instead of talking with the doctor for any length of time, a cursory physical exam(but is weighed and measured and other vital signs taken to insure payment as a higher level visit by the insurer or medicare). They are sent for a CT Scan and perhaps almost assuredly an MRI and maybe even to an ENT man for sinus films. Other tests may be ordered including a general series of blood screenings(cannot even overlook those obscure remote possible related problems). They are given an Rx for some non steroidal antiinflammatory(which most likely will not work as well as the codeine would have but certainly costs far more and upsets their GI tract more). With all the controls now in place and the fear that any opioid will lead to some kid somewhere taking it, selling it or OD'ing on it. After all this exhausting testing the patient has had the million dollar work up. The doctor feels a bit better protected that he did not miss something serious(which his medical acumen should have told him anyway) but is really no less safer from legal action since anyone can sue for anything. Perhaps the patient was talked to abruptly by the young lady at the front desk, or felt they were kept waiting too long, or found out some other test could have been done(maybe not even SHOULD have been done, just COULD have been done). Total cost beyond calculation. And most often, no clear diagnosis is made so the patient goes off to see someone else who repeats everything again and adds a few more tests because they always have to find something. Welcome to the world of medicine in 2015.
Of course much of this is being facetious and i don't really believe that all testing is not of some value, but this happens all too often.
But again, this is anecdotal, not a overall trend. As we've asked repeatedly, show us where doctors are quitting the practice wholesale.
() that innovation might stagnate. Before, you had declared that the PPACA is stifling innovation. It's always nice when someone who demands a bit of authority on the subject forces you guys to walk back your BS.