Anyone who has taken their car to a mechanic and been told that some procedure that is both expensive and a mystery to you is familiar with this dilemma. You want the best for your car, but how do you decide if the work is truly necessary or at least worth the investment?
This is why when proposals are made on how to fix health care, there is also talk about changing how doctors get paid, or calls for more research so there aren't these information problems. The doctor is in a strange spot. Unfortunately, they are not the only strange thing: Customers are strange, too.
We may not have the same apprehension when our doctors tell us we need a certain test, operation or treatment, and I'm not certain we necessarily should. But making an informed, collaborative decisions about health care recommendation ought to be a habit of medical customers.
Informed consent rules obligate doctors to communicate risks associated with and alternatives to recommended interventions. But in our for-profit medical system, it’s no secret that it pays for doctors to recommend or prescribe certain treatments.
I’m searching frantically right now for another NPR piece I heard Monday evening that featured a U.S. military veteran who traveled the world getting recommendations for pain he was having in his shoulder from a past surgery. His orthopedic specialist in the U.S. recommended a very expensive and risky replacement surgery. He got very different recommendations in England, France and Japan. The gist of his analysis of the situation was, of course the orthopedic surgeon the U.S. was going to recommend orthopedic surgery. That’s what he knows and does. (I will post a link as soon as I can find this. If anyone else knows, let me know?)
That’s not to say such a recommendation is necessarily about greed or money, but it does raise a few major questions about informed consent and medical decision making. Can we be truly informed about such decisions? If so, how? If not, how can we protect patients from predatory medicine.
