Doctors Misdiagnose 20% of Illnesses
From The New York Times [reg. req.]:
With all the tools available to modern medicine — the blood tests and M.R.I.’s and endoscopes — you might think that misdiagnosis has become a rare thing. But you would be wrong. Studies of autopsies have shown that doctors seriously misdiagnose fatal illnesses about 20 percent of the time. So millions of patients are being treated for the wrong disease.
As shocking as that is, the more astonishing fact may be that the rate has not really changed since the 1930’s. “No improvement!” was how an article in the normally exclamation-free Journal of the American Medical Association summarized the situation.
This is the richest country in the world — one where one-seventh of the economy is devoted to health care — and yet misdiagnosis is killing thousands of Americans every year.
How can this be happening? And how is it not a source of national outrage?
You mean the real world isn’t like House on Fox?
Under the current medical system, doctors, nurses, lab technicians and hospital executives are not actually paid to come up with the right diagnosis. They are paid to perform tests and to do surgery and to dispense drugs.
There is no bonus for curing someone and no penalty for failing, except when the mistakes rise to the level of malpractice. So even though doctors can have the best intentions, they have little economic incentive to spend time double-checking their instincts, and hospitals have little incentive to give them the tools to do so.
“You get what you pay for,” Mark B. McClellan, who runs Medicare and Medicaid, told me. “And we ought to be paying for better quality.”
There are some bits of good news here. Dr. McClellan has set up small pay-for-performance programs in Medicare, and a few insurers are also experimenting. But it isn’t nearly a big enough push. We just are not using the power of incentives to save lives. For a politician looking to make the often-bloodless debate over health care come alive, this is a huge opportunity.
There’s also an enormous amount of money to be made by doctors, hospitals, labs and drug companies keeping people chronically ill rather than curing them. Once cured, the patients don’t need those services any more.
Not only is there little or no incentive to diagnose correctly, there is even less incentive to actually cure patients.
Patients who require chronic care and patients who because of misdiagnosis are being made sicker by the treatments rack up some pretty big medical bills. Healthy people don’t.
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