Perverse Incentives in Medicine

In the comments, Timothy Beneke wrote:

My experience with a friend who had unexplained stomach pain was instructive. She saw 6 “experts”, 3 who worked for fixed salaries at institutions (Kaiser, Stanford, etc.) and 3 who were in the marketplace getting paid based on what they brought in each year. The three who were on fixed salaries were professionally cordial, and openly admitted that they could not say with confidence what was causing her pain. The three who were not on fixed salaries were very touchy-feely and charming and spoke with complete confidence about the cause.

Wow. This reminds me of my surgeon, Eileen Consorti, telling me that the operation she recommended would help me, that there was evidence for this, and then — when I couldn’t find any evidence — telling me she would find it and never doing so. She would have gotten thousands of dollars for that operation. It also reminds me of my dermatologist prescribing a medicine that didn’t work and, until I did an experiment that showed it didn’t work, having no idea it didn’t work. He got paid in any case.

4 Replies to “Perverse Incentives in Medicine”

  1. The Kaiser-type doctors will be happy to tell you that they don’t know what’s going on, but then they’ll quit trying to find the answer. At Kaiser, if you don’t fit their algorithms, you’ve got a problem. The for-profit docs will keep trying so long as you’re paying them.

  2. My PCP started out determined to discover what had been causing me to suffer mysterious wild twitching in my legs and chest muscles, preceded by migraine auras without headaches, and only at night. He listened patiently, asked a lot of questions, looked at notes I’d kept, really puzzled over it. He even called me a few times to get more info. He seemed genuinely intrigued. Then he decided to start me on Requip for Restless Legs Syndrome even though, as I noted to him, my symptoms were inconsistent with RLS. “Yes, but if it doesn’t work we can rule it out,” was his response. Well sure, we could spend a lot of time ruling out different drugs!

    Instead, I obtained all my medical records from the various doctors I’d seen over a few months (all of whom were mystified, including a Stanford-trained neurologist), reviewed my notes about the occurrences–time, severity, foods I’d eaten, etc., did a lot of Googling, and solved the problem myself. Turned out, blood tests had shown my magnesium was low so I . . . started taking magnesium. Problem solved.

  3. that’s a great great story, dgm

    and that’s a very good point, Dennis. It’s been said that without being wildly overoptimistic nothing would get done because everything turns out to be so difficult. Without wild overoptimism nobody would start anything.

    too bad there isn’t a third type of doctor: satisfaction guaranteed. No pay unless the problem is solved.

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