Notebook > Medicine

Unhealthy decision?

"Unhealthy decision?" Continued...

Issue: "Medical care circus," Feb. 25, 2012

Larimore's tactful way of letting the patient decide whether to pursue screening is exactly the kind of doctor-patient decision-making some believe is threatened by the governmental task force. Whereas a doctor can assess a patient's entire being and help him or her make the best medical decision based on age, risk factors, and health status, a national screening policy treats everyone as a statistic.

"Governments think of populations, not individual patients," Alieta Eck, president of the Association of American Physicians and Surgeons, told me by email. "Governments deal with global budgets and look at the cost of screening as opposed to the cost of one missed diagnosis. If the one missed diagnosis is my patient, I am the one who is potentially held liable."

Eck said she continues to recommend the PSA test, even though only one out of 1,000 test results may point to advanced prostate cancer-"an arguable waste of money for the 999 but priceless for the one. ... The bottom line is that a PSA costs $88. Let the patient decide."

As the government assumes a larger role in healthcare, Scherz's fear is that those decisions will no longer be in patients' hands. And perhaps not doctors' hands, either.

Although the task force guidelines aren't binding on doctors at this point, Scherz said that Obamacare gives the secretary of Health and Human Services new power to set clinical protocols that doctors must follow. Those who don't cooperate will face financial disincentives, perhaps by being barred from participating in insurance plans in the healthcare exchange-a way of influencing physician behavior with a "big stick."

"We are heading toward a healthcare environment where doctors will no longer be working for the patients," said Scherz. "And patients will have to wonder whether or not the doctor who is taking care of them is really looking out for their best interest, or is making recommendations because they are beholden to some other entity."

Regardless of whether the task force is beholden to cost-cutting, a motive is certainly available: Studies have concluded it costs $5.2 million in screening efforts to prevent just one prostate cancer death, and as many as two-fifths of prostate cancers are treated unnecessarily, since they would never have caused problems over the remaining lifetimes of the men involved.

Larimore, for his part, said he's never seen any evidence the task force was taking costs into consideration, but Scherz isn't convinced: According to some calculations, government health services, including tax rebates, already account for more than 50 percent of U.S. healthcare spending.

"If you're paying for something, you have every right to determine the rules of the road," Scherz said. "That's why you get government making regulations and people all up in arms."

Daniel James Devine
Daniel James Devine

Daniel is a reporter for WORLD who covers science, technology, and other topics in the Midwest from his home base in Indiana. Follow Daniel on Twitter @DanJamDevine.

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