Self Interest and Medical Recommendations

Seriously would you ask a car salesman if you need to buy a new car?


What internist or family physician believes that oncologists never get too aggressive with their infusions? Why do they make patients sick with their concoctions that have almost no chance of working?

Why do radiologists often suggest another more expensive study? Why do orthopedic surgeons operate on backs when the data the suggest much more stringent criteria?

Now I have only picked on a few subspecialties because I am tired of providing examples. You provide your own examples.

In all these examples, the physician making the “treatment” decision makes money from that decision. Money influences how physicians make decision, but likely implicitly. I would not be surprised if a subspecialist attacks this rant with an elegant explanation of their decision making. But when money does not matter – at the VA Hospital – I see very different decision making from the same subspecialties. When they are no longer paid by the procedure or encounter, they become much more conservative in their recommendations.

Our payment system encourages aggressive use of technology, because some physician is making money. I do not believe we can control health care costs until we change the monetary incentive system.

When interventional cardiologists make decisions about stenting, we have the equivalent of foxes guarding the hen house. The cardiologists truly mean well, and care deeply about their patients. But, I believe they do too much stenting and too little referring to CV surgeons for CABG. They will argue vehemently. I believe them honorable, but wrong.

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