I live in a small village and whe have two doctors. After visiting doctor A you'll leave with a bag of drugs, doctor B will not give you anything more than you need, even if you ask for it. The crazy part is people prefer doctor A..
One brother was a miraculous curer of all injuries and ills. It did not matter how far a disease or injury had progressed, he could cure the patient. He was known throughout the continent.
One brother was exemplar diagnostician of all injuries and ills. It did not matter what was wrong, he could diagnose the problem and if he was unable to solve the problem he would make a personal introduction the most knowledgeable expert on the matter. He was known throughout the country.
The third brother was just a humble backcountry physician. He wasn't very good at diagnosing or curing diseases. But he visited his clients frequently, and gave them advice on their diet, and home and work conditions. On the rare occasion when his clients got ill or injured, he tended them back to health and when possible helped them to remove the conditions leading to the ill or injury. He was only known throughout the village.
They don't know that though... Instead they will rely on all sorts of proxy indicators, and prescribing lots of tests and drugs is one of them. And no, it's not reliable. On the other hand, doctors have to appeal to these indicators in order to get patients to actually take their advice seriously.
Doctors should use their expertise to advise patients, but in the end people have to be allowed to make their own health decisions. Even if I did believe that doctor B knows better (which I have no reason to), I know I'll get at least the same treatment from doctor A and I'll be able to openly discuss my options.
Who says you can't discuss options openly with doctor B?
Exactly. In my case doctor B once took 30min to explain something I didn't understand, he also grabbed some books for it.. without charging me. One part is true, I can't certainly know who's better.
"doctor B will not give you anything more than you need, even if you ask for it" says that by implication: doctor B seems not to be open to ideas other than his own. That's (personally) not what I would prefer in a doctor.
"I'd like antibiotics."
"Sorry, but we don't prescribe them for colds. Here's why."
I'm a scientist with significant relevant training.
I know more about my own medical history than any doctor I've met. (it may help to understand that locally that we don't have 'family' doctors and are assigned whichever general practitioner is available to bring the notes up on the screen)
I also confident that I'm a far better judge of my own risk and utility profiles than a doctor is. Who is the best person to decide which of a choice of treatments is right, given the costs and benefits? I believe a doctor shouldn't be (unilaterally) deciding that for me.
Even if those things did not apply to me, I would still want a doctor to advise me and then respect my judgment.
That's nice and all, but most people aren't.
This is a little like saying because you're a theoretical nuclear physicist that you should be able to run a nuclear reactor - and so should any random yahoo off the street.
If you scratch that line and read the rest, my other points would apply generally.
We aspire to give people personal choice in their lives. People have the choice to drink or smoke or get obese or even break the law and risk the consequences. People should have that personal choice in their medical treatment as well.
It's a matter of respect for patients.
Well, if that counts, you have the choice to forge a prescription or break into a pharmacy to self-medicate.
Go up a level if you would like to try again.
It is all about incentives. Most PPO systems encourage everyone to spend more money.
- Doctor's want to sell more (and more expensive) drugs. They make more money that way.
- Patients on many PPO plans pay a small flat fee for each drug. Why not go with the more "expensive" one? Its all the same to the patient.
- The government and insurance companies work together to outlaw cheap plans and force people to over-buy for coverage the patients either don't need or expenses that are predictable.