Staying Away from Doctors – The New Cost-Containment Movement 

An apple a day keeps the doctor away.

19^th Century Aphorism

July 26, 2012 -  Go to Google. Click  on “Staying away from doctors,"  and you will find a host of reasons to stay away from doctors to contain health costs.   These include not only an apple a day, two bananas a day,  five fruits and vegetables a day,  more exercise, fewer prescription drugs, no cigarettes, and good health.   These are commonsensical suggestions, and I applaud them.

If you feel fine,  have no symptoms,  and enjoy good health, stay away from doctors.    Doctors , it is said,  will order unnecessary tests,  will cause unnecessary anxiety and alarm, and may even casue  harm you by pursuing borderline abnormal tests.

In a New York Times blog today, "Too Much Medical Care?". Tara Parker-Pope, a widely respected health care journalist,  lays out that “too much medical care” scenario.  The U.S. spends 50% more on health  care than any other industrialized because of excess health care spending on doctors and hospitals. 

Parker-Pope cites these figures causing high costs

• Unnecessary Services = $210 billion (27.4%)
• Inefficiently Delivered Services = 130 billion (17.0%)
• Excess Administrative Costs = 190 billion (24.8%)
• Prices that are Too High = 105 billion (13.7%)
• Missed Prevention Opportunities = 55 billion (7.2%)
• Fraud = $75 billion (9.8%)

Note that unnecessary services,  inefficient delivery,  high administrative costs, and prices too high  together account for almost 90 % of medical costs. Presumably many of these costs could be done away with if patients did not see the doctor at all.  

I suppose that is so.   Not mentioned in her analysis are defensive medicine engendered by physician concern over malpractice,  patients going to doctors for minor concerns such as URIs or minor backache and expecting antibiotics and MRIs, expenses secondary to private and public bureaucratic demands for documentation,  the lure of “free” care covered by private and public third parties,  and the high expectations of patients desiring to have everything possible done that can be done.

On the “missed prevention opportunitities,” how do you tell patients to stay away from doctors when the patient wants a physical to check on the state of their health,  when they want to know what their cholesterol or blood glucoes is,  when they seek drugs for depression or anxiety or hypertension, when they want a mammogram to rule out breast cancer, or when they want an antibiotic for a viral infection?

Our reporter presents the case of her elementary school daughter’s painful ankle. The daughter  sees multiple specialists ( a pediatrician, a sport medicine doctor, an eye specialist,  a pediatric rheumatologist, and a pediatric orthopedic surgeon.),  has an exhaustive workup, including at least three MRIs and multiple blood tests, and ends with a  pain regimen that solves her daughter’s problems.

Would I be out of line if I suggested that 3^rd party intervention might be responsible for driving up many of these costs?   This intervention creates the mindset that in the end someone else pays, not the patient, and desensitizes patients and doctors alike to the true cost of care, and in the process creates a private and public bureaucracies to monitor and measure care and build unrealistic expectations of what that care can accomplish.

Tweet:  Lately a movement has been growing telling healthy patients or those with minor ailments to stay away from doctors to save money.