Cortisol

OK, so this article about the President's address to the AMA grinds my gears a bit-- not just as the son of physicians and a future doctor myself, but as a logical person who appreciates balanced reporting.

I'm okay with Obama not limiting jury damages in malpractice cases, and I get where he's coming from. I'm not proud of the fact that he got booed. But what really bugs me is the lack of understanding displayed by the criticism of doctors for contributing to the inflated cost of health care by ordering "unnecessary tests." I can't claim expertise in the matter, but it seems to me that if doctors were not quite so afraid of being embroiled in malpractice suits over negligence, they could relax their hyperactive testing and procedures a bit. Don't get me wrong: I'm sure a lot of doctors are greedy SOBs who do it for the kickbacks, but you can't tell me that's the motivation in every case. So it troubles me that there seems to be a change in the prevailing winds, that now accusatory fingers are being pointed squarely at doctors, often without appropriate context.

Undoubtedly, some people actually know what they're talking about. And yes, Atul Gawande, I'm looking at you. As Dr. Gawande explained, the nation's doctors must cut down on the exorbitant expenses incurred by patients, but he recognizes the complexities of the issue:

"Fixing this problem can feel dishearteningly complex. Across the country, we have to change skewed incentives that reward quantity over quality, and that reward narrowly specialized individuals, instead of teams that make sure nothing falls between the cracks for patients and resources are not misused [emphasis added]."

The skewed incentives are not only the monetary rewards that doctors gain by loading up on dubious rigmarole, but the incentive to avoid accusations of negligence. Pace organic chemistry, the specter of malpractice is one of the scariest things faced by aspiring physicians. Reading ER doc blogger WhiteCoat's "Trial of a WhiteCoat" series (which is the ongoing account of his own malpractice suit), I can't help worrying that someday I'll also be held accountable for negligence if I don't order some test or consult some specialist quickly enough, and a grieving family assumes that my hesitation to call in the heavy artillery was what killed their loved one. So I completely understand the urge to open up with the whole battery of technological marvels, fill them full of contrast and blast them with radiation, poke, prod, jab, scan, biopsy, and consult with the experts in the interest of avoiding someone suing your scrubs off. So the criticisms being leveled at the doctors are perhaps valid, but they need to be contextualized in order to be fair.

Oh, and this quote?

Obama did not blame the doctors. Instead, he tried to woo them, much as he has done with recalcitrant foreign leaders.

Really, is it really necessary to lump us in with Ahmadinejad and Co.? I don't think so.