From the New York Times, a review of a book that directly touches the life of everyone with a disability.

“Overtreated,” by Shannon Brownlee, analyzes what’s wrong with a health care system that spends far more money per person on medical care than other countries and still seems to get worse results.

Drawing on the work of Dr. Jack Wennberg of Dartmouth Medical School, Brownlee illuminates a process that has turned doctors into pieceworkers, to the detriment of both patients and society at large.

… as Ms. Brownlee puts it, [doctors are] “paid for how much they do, not how well they care for their patients.” Doctors and hospitals typically depend on the volume of work for their income, and they are the gatekeepers who decide when work needs to be done. They also worry about being sued if they do too little. So they err on the side of overtreatment.

Patients play a role, too. We’re entranced by the wonders of modern medicine and fooled by our byzantine health insurance system into thinking that we’re not really paying for all those unnecessary spinal fusions.

The typical book about current affairs is better at describing problems than solutions. But there is a nice surprise at the end of “Overtreated.”… In plain English, Ms. Brownlee lays out an agenda for reform that is usually confined to academic journals.

It includes some steps that should be widely popular, like giving doctors incentives to explain the risks and benefits of procedures more clearly than they do now. Research has shown that patients frequently decide against marginal care when they know the true risks and benefits. Malpractice laws would also need to be changed so doctors were not sued by patients who later changed their minds.

Other solutions would be more difficult — because medical evidence is often murky, because hospitals and insurers would fight to keep their revenues and because most Americans think it’s the other guy who’s getting unnecessary treatment.

This entry was posted on Wednesday, December 19th, 2007 at 5:55 pm and is filed under NOT2BEMISSED, books, chronic illness, law, medicine. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.  Email This Post