The Guilty Doctor

July 28, 2010
Shrink Rap

Many will say that when it comes to the skyrocketing costs of health care, doctors are responsible for part of the problem.

This article originally appeared on Shrink Rap.

Times are tight and we're all looking to save money, be it our own or someone else's. Many will say that when it comes to the skyrocketing costs of health care, doctors are responsible for part of the problem. We order too many tests, either to cover ourselves in the event of a malpractice suit, or because patients pressure us, or because we genuinely believe that the tests are necessary for patient care, but in many circumstances, a cheaper option is available. We order medications that are expensive when cheaper medications are available. And psychiatrists offer care-- like psychotherapy-- that could be done by clinicians who are cheaper to educate and willing to work for less money.

Here are some voices on decreasing cost: From KevinMD's post on when patients (in this case the patient is a doctor), pay cash. More on the same story directly from Jay Parkinson, here is Today I Was a Patient. The most absolutely cool thing I learned from Dr. Parkinson this morning is about a website I had never heard of before calledZocDoc which lets people schedule on-line appointments with new physicians (including shrinks!)--like OpenTable for Docs...I asked for more info about this, but such a website fits Roy's vision of dying and going straight to heaven. And MovieDoc has strong opinions on allocating resources: we shrinks should not be letting patients ramble on about their romantic lives, why one psychiatrist can treat 1,000 patients if they stop that psychotherapy nonsense! ClinkShrink, too, has had a lot to say about allocation of services, but I'll stop now before the blog explodes.

I buy it, too. Docs should feel an obligation to care about cost-containment. In recent times, this translates very simply into the fact that I feel guilty no matter what I do. I sit with a patient and I consider trying a cheaper option for medications before I try a more expensive one. But then I think: isn't my obligation to do my very best by this patient? Why shouldn't my patients get the latest-greatest available medication when other patients do? And what's the cut-off for how much it's worth for....relief from voices, a better mood, a good night's sleep? How do we even begin to put dollar signs on such things?

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Shrink Rap Dinah blogs at Shrink Rap, a blog by Psychiatrists for Psychiatrists. A place to talk; no one has to listen. All patient vignettes are confabulated; the psychiatrists, however, are mostly real. --Topics include psychotherapy, humor, depression, bipolar, anxiety, schizophrenia, medications, antidepressants, antipsychotics, ethics, psychopharmacology, forensic and correctional psychiatry, psychology, mental health, chocolate, and emotional support ducks. Don't ask.