Does NY Times Editorial Demonizing Doctors Signal That Health Reform Is In Trouble?

If you haven't seen the NY Times Sunday (6/12/09 p. 7) editorial "Doctors and the Cost of Care," you should check it out. It focuses on a report by Harvard-affiliated Dr. Atul Gawande who concluded, after investigating high Medicare health care costs in McAllan Texas (population-141,000 with 103 physicians per 100,000 which is less than the U.S. average), that doctors' over-treatment of patients was responsible. Citing Dartmouth Research, the editorial echos the opinion that " . . . more costly areas and institutions provide a lot more tests, services and intensive hospital-based care than the lower cost centers . . . . yet their patients fare no better and often fare worse because they suffer from the over-treatment."

Numbers? Where are the numbers? Whose doctor is it that is testing too much and over-treating? Is the indictment applicable to 2 percent of the physician population, 98% of the physician population, or 50 percent of the physician population. Are these doctors practicing outside the standard of practice for their specialties (these days, even family practice is a specialty)? If they are, the solution is medical board investigation and disciplinary action, medical staff investigation and disciplinary action at the local level, and (unfortunately) appropriate lawsuits for poor practice conduct resulting in injury. But if these physicians are practicing within the standard of practice one must ask, what is the problem? Or is there a problem?

Yes, there is a problem. In part, it is in the education system that provides basic medical education and continuing medical education which is often influenced by pharmaceutical and medical device companies (through their detail personnel, hired-hand expert speakers, subsidized medical journal articles). There is also a problem with direct-to-patient advertising which is focused on having the patient demand the sponsor's product on his or her next visit to the doctor's office or even the urgent care clinic or emergency room. Pharmaceutical companies and device manufacturers, and in some cases universities trying to corner the medical market, set a "standard of medical practice" which is profitable for them and implicitly threatens those doctors who don't prescribe their products as "practicing outside the professional standard" which these companies have conned physicians and the public into believing is appropriate.

It also involves the marketing departments at HMOs, which measure health care quality in terms of "patient satisfaction" which is an entirely different concept. Under the marketing perspective, if a patient is disappointed because her doctor doesn't prescribe an antibiotic for influenza, the doctor is not satisfying the patient and is not providing the quality of care that sells HMO reenlistment. If a 20 year-old male is embarassed when the doctor checks for testicular cancer, the HMO marketing department may be unhappy, though the doctor may be saving lives through this 30 second examination.

When the Times labels physician behavior as "profligate" without providing a carefully investigated factual basis for its serious charge, and when the White House is referenced, I have to conclude that health reform is so threatened that political forces have stooped to demonizing physicians. The American public deserves better from the White House and the Times.