The Drs TV: Medical Over-Treatment, Surgery Quotas & Cookbook Medicine

The Doctors: The Right & Wrong of Health Care

Dr. Travis Stock sat down with guests Dr. Martin Makary, author of Unaccountable: What Hospitals Won’t Tell You and How Transparency Can Revolutionize Healthcare, and Dr. Leana Wen, author of When Doctors Don’t Listen: How To Avoid Misdiagnoses and Unnecessary Tests. 

Dr. Travis said that there’s a lot of things the health care community is doing right and a lot of things they’re doing wrong.

The Doctors: Medical Over-Treatment

Dr. Makary said there are a number of problems in health care like malpractice. But the worst problem of all, he said, was the over-treatment problem. The Institute of Medicine says that one-third of the entire health care expenditure is going to things like fraud, medications patients don’t need, and tests patients don’t need.

“We have a system where we have good people in an ugly network of perverse incentives that rewards the wrong things and that has a culture which is a reflex culture,” he said.

He said that doctors immediately treat by reflex instead of on a case by case example. Dr. Leana Wen agreed, saying that she believed too often doctors are too careful. She said that there was a patient that came in with a headache after drinking the night before. She said it was clear that it was a hangover headache. The doctor who saw her ordered a cat scan and a spinal tap. “I mean, that’s crazy,” she said.

The Doctors: Cookbook Medicine

Dr. Leana Wen said that a lot of problems in medicine today is what she calls “cookbook medicine.” She said cookbook medicine is when a doctor has a patient with chest pain and prescribes for that patient the same treatment he would give any patient with chest pain. “That’s following a recipe and not tailoring the care to your symptoms and your body,” she said.

Dr. Travis said that the law favors doctors who “follow the recipe.” He said that the system penalizes doctors who think outside the box.

Dr, Martin Makary said that a lot of times patients sue not necessarily because of the event, it’s the patients feeling dissociated from a “closed-door culture.” They want to know what is happening and why. “People are hungry for honesty in health care,” he said.

The Doctors: Doctor Quotas

Dr. Makary said that doctors are under quotas, not just to see so many patients in an hour, but how many operations they’re getting done. Dr. Makary said that he knows surgeons at hospitals around the country getting text messages telling them they’re behind on their monthly quotas of operations. “That’s offensive. That’s why doctors are standing up and saying, ‘We don’t want to be paid purely on volume and quantity. We want to be paid on quality,'” he said.

The Doctors: How To Avoid Getting Bad Medical Care

An audience member asked how to avoid getting bad medical care, like the story that The Doctors had earlier in the program about a doctor who purposefully misdiagnosed his patients with cancer and gave them unnecessary chemotherapy in order to make money from Medicare claims.

Dr. Travis said that when you’re a patient, you have the right to question what is happening and what is being recommended for you. He said you should follow your gut. He said that in his entire career, he couldn’t name one colleague in the emergency department of the hospital that he wouldn’t send a family member to. However, if you feel uncomfortable and you think something is strange, you have to become your own advocate.

The Doctors: How To Get Around Cookbook Medicine

An audience member asked how patients can get the doctor to go beyond the recipe. Dr. Leana Wen said that we know that cookbook medicine is a bad approach. 80 percent of diagnoses can be made just based on your story. The symptoms that you have and the history of what’s going on. Dr. Wen recommended really trying to make it clear to the physician that you’re different from other patients.