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Selected news articles which highlight important policy issues.

News: Weekly Archives

News for the week of 11-30-2005

When the doctor is in, but you wish he wasn’t
The New York Times, 11-30-05

Editor’s Notes:

In most industries, the customer is king (or queen). Dry cleaner lose your shirt? They’ve lost all your other business too. Car mechanic bungle the repairs? Find another one down the block. Bad service at your neighborhood restaurant? Write a nasty letter to Zagat’s. Most professions live in fear of their customers, and with good reason. Customers control their own spending and have a wide array of competitors to turn to if they don’t get the kind of service they want.

This New York Times article, however, reminds us that health care is an entirely different animal. In this business the “customer” (i.e. patients) often quietly accept behavior from doctors (ranging from condescension to outright abuse) that they would never tolerate from anyone else.

[Some] doctors may be arrogant or rude, highhanded or dismissive. They drive away patients who need help, and some have been magnets for malpractice claims.

And while such doctors have always been part of medicine, medical organizations say they fear that they are increasingly common - doctors, under pressure to see more patients, are spending less and less time with each one and are replacing long discussions with laboratory tests and scans - and that most problem doctors apparently have no idea of their patients' opinions of them.
Patients usually do not confront doctors. Instead, most rant to friends or family members about their experiences or simply change doctors. But in most areas of the country, there is an abundance of patients. If a few patients leave a medical practice, plenty more can take their place, so doctors may never even know what their patients think.

But the article also doesn’t mention at all one of the chief reasons that patients get bad service: they’re not paying for the doctor’s time, someone else is (their employer or insurer). Doctors, in short, are paid not for the quality of the service they provide to the patient, but by a contract with a third party.

The article implies that doctors are so harried for time that they skimp on social niceties, which seems a bit far-fetched. If Starbucks and McDonald’s can figure out how to make a surly fifteen-year old courteous and helpful during a sixty-second interaction, why can’t doctors?

Some physicians and insurers are beginning to take patient satisfaction more seriously, incorporating patient feedback into performance reviews, bonuses, and the like. But this is far from enough. When push comes to shove, the person who pays the piper calls the tune. If more patients paid for their own routine (non-emergency) care, these encounters would be much more polite, and probably much less expensive. Consumers would have an incentive to economize on routine care, thereby freeing up more time for doctors to spend with patients who have truly serious health issues.

This article underscores the importance of consumer-driven health care. Despite all of the media hand-wringing over out-of-pocket costs to American patients, paying more can actually empower patients to ask more questions and demand better results from health care providers.

[permanent link]

Drug shows promise in lupus patients
Newsday, 11-30-05

Editor’s Notes:

Lupus is a mysterious, chronic autoimmune disorder for which there are few good treatments. One of those treatments, however, is actually an off-label drug called CellCept, originally used to prevent rejection in organ transplant patients. The results of off-label use have apparently been so promising that they’ve led to a small, but important clinical trial on the drugs’ effectiveness in treating one of the most dangerous lupus complications, lupus nephritis, a condition where the patient’s immune own system attacks the kidneys.

After more than 30 years without a new form of treatment, doctors in Brooklyn have found that people with lupus-related kidney disease can be safely treated with a drug developed to prevent organ rejection.
Word of the advance comes in a report that appeared in last week's issue of the New England Journal of Medicine. Even though the study was very small, consisting of only 71 patients who received the anti-rejection drug, the advocacy organization for lupus patients is lauding the findings as a breakthrough.
“There's no doubt that we need additional studies," said Sandra Raymond, president of the lupus Foundation of America, "but the study is very, very promising and patients with lupus kidney disease are excited about it."

The article also notes that the standard treatment for lupus—Cytoxan, a cancer drug—also has several dangerous side effects, meaning that CellCept could represent not only an improvement in treatment, but quality of life as well. More information on lupus related research can be found here.

[permanent link]



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