Zašto Amerikanci toliko troše na zdravstvo?

by Miloš Miljković

Zato što nisu navikli da čekaju. Najbolji lek za uganuće zgloba je vreme. Hiperaktivnim pre-podne-trčim-uveče-dižem-tegove japijima to ne ulazi u glavu; hoće da se sve popravi odmah, kao da im je telo auto koji mehaničar može čas da remontuje. Ovakvi mogu biti i roditelji, od kojih neki imaju kolumnu u NYT:

After years of reporting on health, I considered myself a well-informed patient, but it took my elementary-school daughter to state the obvious: She was the victim of too much medicine. Every new blood test, scan or X-ray raised new questions, which led to more lab work, scans and X-rays. I know the doctors had good intentions, but it’s a truism of modern medicine that the more you test and scan and look for problems, the more likely you are to find something wrong. My daughter’s case had spiraled out of control.

(via Tara Parker-Pope: Too Much Medical Care? – NYTimes.com)

Nisu samo pacijenti nestrpljivi. Ni doktori nemaju vremena:

We in medicine no longer spend time doing the careful history and physical examination that will minimize these costs. Our insurance system, unfortunately following Medicare’s lead, pays more for tests than for a careful examination. A careful history and physical takes time. But we in medicine are not “rewarded” for taking enough time with patients. Our administrators tell us that we have to see more patients per hour. They focus on the volume not the experience.

(via High value, cost conscious care – the antithesis of too much care — db’s Medical Rants)

Patients (and physicians) too often forget that time is our friend. We become impatient when the physician cannot explain the symptom(s) immediately, so we abandon our generalist and figure that the subspecialist is a better choice.

(via More thoughts on high value, cost conscious care — db’s Medical Rants)

A subspecijalista će, kada mu pošaljete pacijenta, obaviti bar jednu od širokog dijapazona dijagnostičkih i terapijskih procedura za koje osiguranje lepo plaća1. Indikacija se lako iznalazi.


  1. Ovo nije (isključivo) zbog para. Kao što ne biste plaćali vodoinstalatera da samo pogleda cevi i kaže da je sve u redu, tako i subspecijalisti očekuju da onaj ko im šalje pacijenta već zna da nešto fali, a da su oni tu da pripomognu nekom kolonoskopijom, injekcijom steroida u koleno i sl.

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