• Quick note - the problem with Youtube videos not embedding on the forum appears to have been fixed, thanks to ZiprHead. If you do still see problems let me know.

Why Doctors Hate Science

Well said skeptigirl.

The rewards are many, the honors many. What other profession allows you the privilege of attending the final moments of a stranger's grandfather, the first moments of a newly born daughter? What other profession provides you with a glimpse of the deepest, and many times darkest, secrets within a man/woman.

I have smiled and felt a lump in my throat as I have lifted a newborn into the hands of a waiting mother. I have held the hand of an elderly woman until she drew her last breath. I have held back tears as I told a mother and sister that their son/brother was killed. Most in my profession have...and it is an honor to be allowed the privilege.

There is no profession like it on earth.

So ya, as I have said above, it is a career, but by far, it is, in my mind, the greatest career anyone could hope for. If it were simply about money, I wouldn't be working in Atlantic Canada, I assure you.

TAM:)
 
T.A.M. said:
Well said skeptigirl.

The rewards are many, the honors many. What other profession allows you the privilege of attending the final moments of a stranger's grandfather, the first moments of a newly born daughter? ..
Click to expand...
Amazing you should bring up these examples. One of the earliest things I was awestruck with by my profession was thinking how amazing it was I had seen people born and die and how rare it was in our society to watch such important parts of our lives.
 
Ivor,

You've heard from T.A.M. and Skeptigirl.
Now listen to your very own reference on SID:

http://www.buseco.monash.edu.au/centres/che/pubs/wp81.pdf

doctors exert greater effort when there is a need to do so.
Click to expand...
the existence of SID does not necessarily imply the need to regulate the medical market, if doctors are inducing services that are health promoting
Click to expand...
Casual observation strongly suggests that doctors firmly believe in the efficacy of their own treatments and, indeed, it would require a remarkable personality to believe that the training and practice of a lifetime did not result in the creation of highly valued services
Click to expand...
The behaviour postulated here would be less likely to occur if the doctor’s only motivation was the maximization of profit...the majority..of doctors have...only limited interest in...profit maximization, but a major concern with the achievement of professional objectives through the provision of what is perceived to be valued and needed medical services.
Click to expand...
The general point is that there are multiple explanations for doctor behaviour that are consistent with demand shift if the dynamics of the market are combined with the assumption of weak profit maximization, belief in the efficacy of the services provided, and a professional commitment to ethical behaviour.
Click to expand...

regards,
BillyJoe
 
Ivor,

I'm going to do one more thing for you.

I'm going to tell you what that paper you referenced is all about. But first I'm going to give you the chance to tell me. I think it should take only a small paragraph. So, if you haven't actually read it, as I suspect (and I sincerely apologise if you have), hey, it's only 35 pages long!

Okay, I'm feeling generous today, so I'm going to make it easier for you. You can skip the 3 pages of acknowledgements at the start, the 8 pages on cross-sectional data in the middle (I'll explain why later), and the 9 pages of references and appendices at the end. That leaves only 15 pages.

Enjoy!

BillyJoe
 
Yuri Nalyssus said:
If that was the case then presumably more unnecessary procedures would be done in places where doctors were on performance related pay. Is there any evidence for this?

Yuri
Click to expand...

There's this. It's more about unnecessary visits than procedures, though.

http://pediatrics.aappublications.org/cgi/content/abstract/80/3/344

Physician Reimbursement by Salary or Fee-for-Service: Effect on Physician Practice Behavior in a Randomized Prospective Study
Gerald B. Hickson MD1, William A. Altemeier MD1, and James M. Perrin MD1

1 From the Department of Pediatrics, Vanderbilt University, Nashville, Tennessee



We used a resident continuity clinic to compare prospectively the impact of salary v fee-for-service reimbursement on physician practice behavior. This model allowed randomization of physicians into salary and fee-for-service groups and separation of the effects of reimbursement from patient behavior. Physicians reimbursed by fee-for-services scheduled more visits per patient than did salaried physicians (3.69 visits v 2.83 visits, P < .01) and saw their patients more often (2.70 visits v 2.21 visits, P < .05) during the 9-month study. Almost all of this difference was because fee-for-service physicians saw more well patients than salaried physicians (1.42 visits and .99 visits per enrolled patient, respectively, P < .01). Evaluating visits by American Academy of Pediatrics' guidelines indicated that fee-for-service physicians saw more patients for well-childcare than salaried physicians because they missed fewer recommended ommended visits and scheduled visits in excess of those recommendations. Fee-for-service physicians also provided better continuity of care than salaried physicians by attending a larger percentage of all visits made by their patients (86.6% of visits v 78.3% of visits, P < .05), and by encouraging fewer emergency visits per enrolled patient
Click to expand...

The effect is not huge, and I would guess it's more of a subconscious bias popping up from the incentive than "corruption".

I'm pretty sure this principal (physicians respond to financial incentives by altering clinical practice) is behind the P4P initiatives, isn't it?
 
fls said:
Do you know who she's reacting to?

Linda
Click to expand...

Stuff like this Washington Times editorial, I bet:

http://www.washingtontimes.com/news/2009/feb/11/health-efficiency-can-be-deadly/

Secreted in the House version of the stimulus bill the President is trying to rush through Congress is the germ of a major overhaul of the American health care system. One provision causing increasing concern is the future role of the National Coordinator of Health Information Technology, who will be in charge of collecting and monitoring the health care being provided to every American.
Click to expand...

The purpose of the database is to help increase health care "quality, safety and efficiency." The first two goals are commendable, but what does efficiency mean?
Click to expand...

There is no telling what metrics will be used to define the efficiencies, but it is clear who will bear the brunt of these decisions. Those suffering the infirmities of age, surely, and also the physically and mentally disabled, whose health costs are great and whose ability to work productively in the future are low.
Click to expand...

This notion is fully in the spirit of the partisans of efficiency but came from a program instituted in Hitler's Germany called Aktion T-4. Under this program, elderly people with incurable diseases, young children who were critically disabled, and others who were deemed non-productive, were euthanized. This was the Nazi version of efficiency, a pitiless expulsion of the "unproductive" members of society in the most expeditious way possible.
Click to expand...




:rolleyes:
 
skeptigirl said:
I don't believe any in the medical community here on the forum have claimed no health care providers are primarily motivated by financial reward. In fact, I'll go even further and say a few medical specialties are entered because they offer greater financial reward, not that everyone in those specialties is so inclined.

But what you seem to be missing is the fact most of us are motivated by professional rewards. That can be anything from being the top surgeon, a Nobel winner, a discoverer of cancer cures, to helping the poor around the world or teaching students. Being good at what you do is extremely rewarding, especially in the medical profession.
Click to expand...

I'm not missing anything at all:

Posted by Ivor (#57) said:
Direct financial reward is not the only incentive for medical professionals to engage in SID.

It has already been mentioned that physicians in the US often perform tests they know are pointless to protect themselves from being sued (though this may also be used as a rationalisation to justify extracting more money from the patient:)). This would be SID to avoid a possible loss of money and public image. SID may also occur for internal rather than external payoffs. E.g., associating more care with better care.
Click to expand...

The overarching priority for a medical professional is to be an advocate for what her patient wants, not what she wants. As soon as she lets her personal motivations (e.g., being the top surgeon, a Nobel winner, a discoverer of cancer cures, to helping the poor around the world or teaching students) interfere with her patient's treatment choices, SID will likely occur.
 
Ivor the Engineer said:
I'm not missing anything at all:



[snip] As soon as she lets her personal motivations (e.g., being the top surgeon, a Nobel winner, a discoverer of cancer cures, to helping the poor around the world or teaching students) interfere with her patient's treatment choices, SID will likely occur.
Click to expand...
Good grief, now you've twisted pride in doing a good job into a grab for personal fame.

Earth to Ivor, some of us consider what the patient wants IS a big part of doing a good job.

[the snipped part]The overarching priority for a medical professional is to be an advocate for what her patient wants, not what she wants.
Click to expand...
:id:

You should consider your own words here considering you have so much to say about what your personal preferences are for what the NHS should or shouldn't cover.
 
Last edited:
Ivor the Engineer said:
And I'm going to tell you to stop with the patronising tone.
Click to expand...

Well, you must have clapped your hands with joy when you read that line. Now, instead of posting insubstantial replies to my posts amongst slabs of copy-and-pastes, you have an excuse to simply not answer at all.

Oh well, I suppose I should have put a smiley in there somewhere. :(

BJ
 
skeptigirl said:
Good grief, now you've twisted pride in doing a good job into a grab for personal fame.

Earth to Ivor, some of us consider what the patient wants IS a big part of doing a good job.
Click to expand...

I'm sure I read several posts (some of which were by physicians) which stated that many medical procedures are performed to avoid being sued by a patient. E.g.,

paximperium said:
My anecdotal experience:
macdoc said:
How much of this is

Cover my ass? 50%

Profit driven? 10%

Ignorance of current best practice? 40%
Click to expand...
Click to expand...

In many cases CYA is supplier induced demand.

You should consider your own words here considering you have so much to say about what your personal preferences are for what the NHS should or shouldn't cover.
Click to expand...

As a member of society who contributes to the UK's NHS I am entitled to express an opinion* as to what services I think it should and should not cover. Do you disagree?


*Though I appreciate and am not bothered that no one particularly cares about what I think.:)
 
Oh, and T.A.M., Paximperium, and Skeptigirl...

...don't you dare enjoy yourselves while you're helping all those patients. :D
 
balrog666 said:
As opposed to every other profession?

:rolleyes:
Click to expand...

Physicians as a group are no worse or better than any other professional group at attempting to game the system in their favour. The primary difference is in the opportunity physicians have to do it compared to other professionals.
 
Ivor the Engineer said:
I'm sure I read several posts (some of which were by physicians) which stated that many medical procedures are performed to avoid being sued by a patient. E.g.,
Click to expand...
And that somehow equates to me not enjoying my job or caring about what my patient's want?

Well selective quoting and cherry picking is your forte after all.

In many cases CYA is supplier induced demand.
Click to expand...
Repeatedly repeating this claim does not magically make it true.
 
Ivor the Engineer said:
Physicians as a group are no worse or better than any other professional group at attempting to game the system in their favour.
Click to expand...
Congratulations, you've just proven that physicians are human...again and again and again...a fact that no one has an issue with at all.

The primary difference is in the opportunity physicians have to do it compared to other professionals.
Click to expand...
Congratulations. You've made a repeated claim that has yet to magically become true.
 
You must log in or register to reply here.

Back
Top Bottom