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Doctors' Guilds Protect Useless Spending

In 2012 medical guilds began to release lists of unnecessary or untested services. Because patients often undergo costly procedures without seeing any measurable health benefit, experts believed it would be possible to crunch the numbers and come up with a list of procedures for doctors to avoid. Hospitals could then scale back these procedures, and patients could be more wary about undergoing them.

But as Kaiser Health News’s in-depth study of these lists shows, things didn’t quite work out as planned. For some specialist fields, the no-go lists seemed to do some good, but in other fields, the lists only included services that aren’t very profitable for specialists. The articles gives joint surgeons as a representative example:

The American Academy of Orthopaedic Surgeons discouraged patients with joint pain from taking two types of dietary supplements, wearing custom shoe inserts or overusing wrist splints after carpal tunnel surgery. The surgeons also condemned an infrequently performed procedure where doctors wash a pained knee joint with saline.

“They could have chosen many surgical procedures that are commonly done, where evidence has shown over the years that they don’t work or where they’re being done with no evidence,” said Dr. James Rickert, an assistant professor of orthopedic surgery at Indiana University. “They chose stuff of no material consequence that nobody really does.”

Others took a different route than the joint surgeons, choosing to list procedures performed by other specialist doctors. Kaiser:

“They were willing to throw someone else’s services into the arena, but not their own,” said Dr. Nancy Morden, a researcher at the Dartmouth Institute for Health Policy & Clinical Practice in New Hampshire.

Medical opinion is legitimately divided about the usefulness of certain treatments; reasonable doctors could decide to provide services that others might fight superfluous. But this report is a good indicator that there are indeed medical guilds out there that are more concerned with protecting their members’ income than with cutting back on waste in the U.S. health care system. We’re sure everyone is shocked—shocked—by this news.

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  • MontyBurnz

    Lawyers are way worse.

  • Andrew Allison

    As in the case of the medicare drug issue recently reported upon here, the incentives are all wrong. Self-interest rules. As with the drugs problem, the solution is to not reimburse doctors for unnecessary procedures and testing, thereby establishing just how convinced they are of the need. Medical opinion might be divided, but outcomes speak to the illegitimacy of one side’s arguments. Like any other guilds, medical guilds have shown themselves to be more concerned with members income than healthcare. Perhaps it’s time to rename it the Hypocritic Oath.

  • Jacksonian_Libertarian

    Never ask a Barber if you need a hair cut. The informed consumer is the only one with enough skin in the game to make decisions about medical treatments. In order for Healthcare to behave like a free market, the consumer must be heavily exposed to the costs. Only when the doctors and medical facilities must face the “Feedback of Competition” will they be forced to continuously improve Quality, Service, and Price. Outrageous wait times, surly and rude service, unnecessary drugs, tests, and procedures, are all evidence of a dysfunctional and unfree market.

    As an example of a medical free market let’s look at what has happened to Lasik surgery which insurance doesn’t cover. Starting from radial keratotomy surgery 30 years ago, and quickly progressing through several different methods, the technology has improved to lasers, quality has improved, service has improved (it’s outpatient surgery), and prices have dropped ($299 per eye). Now imagine that happening all over the entire medical industry. We would swiftly see same day doctor visits, diagnostics would come to resemble the Star Trek Tricorder in speed and accuracy, drugs would be custom designed to the microgram and administered not once per day but as needed, there would be rapid technological advancement, and prices would fall while average health would see vast improvement.

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