re: My anecdotal evidence of one reason why healthcare is so fricking high..., and rising!

I sympathize with your story, but let me explain it from the physician side of the fence.

quote:

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Doctor says what am I seeing you for today, I tell him I'm having severe sinus pressure, so he looks in my ears, down my throat and up my nose. He then says how long have you been having these symptoms? I tell him off and on for years and then I tell him what was done to treat my sinus troubles in the past. I tell him that on my last visit y'all had X-rays done, said I had a sinus infection, was prescribed an antibiotic and it cleared up for a few months and now it's back. So he promptly orders X-rays of sinuses, says yep you have a sinus infection and prescribed an antibiotic......, again.

What's the money maker on these repeated trips to the doc for sinus trouble...., bingo, the X-rays. Quick and easy cha-ching for around $140 dollars and for the most part the X-rays are unnecessary considering my medical record documenting numerous visits for the same issue.

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The doctor who ordered your x-rays didn't make any money from ordering them. The majority of that money went to the company that owned the xray machine and the company that employed the radiologist who read the xray.

You may have thought that your doctor came up with this plan of treatment, but he didn't. It was a plan of treatment that the combination of malpractice lawyers and insurance companies demanded he use.

If he didn't order the xrays for you and your wife and only used his clinical judgement, if something was wrong, his failure to order xrays would be used as a "breach of the standard of care" in the accusation made by a malpractice lawyer. In fact, pretty much any test you don't run can be used as such an excuse, so doctors in the US run a lot of tests in comparison to countries where they don't have the malpractice system we have here. For example, there are five times as many malpractice suits filed in the US compared to Canada...and that's not because Canadian physicians are 5x more competent.

As far as the MRI goes, most doctors have a pretty good idea of whether something is a bone injury, a ligamentous/meniscus injury, or possibly both based on the mechanism of that injury. All also know that an X-ray isn't going to show the meniscus injury.

However, because MRIs are expensive, a non-medical beancounter at an insurance company (and don't think government health care is a solution for this because CMS does the same thing) has set up "hurdles" that you have to clear to get the expensive diagnositic tests. They don't let you just order an MRI because you think a patient needs one. Well you can, but then they will deny payment and your patient will get stuck with the bill. So the x-ray comes first, then perhaps physical therapy, then maybe an MRI. The whole goal is to provide a series of less expensive "off ramps" along the treatment pathway before a patient gets to surgery.

The entire goal of both private and government health care is to demand that doctors suspend their clinical judgement and follow these diagnostic and treatment pathways which are designed with one goal in mind: keep it simple, keep it cheap, make money for the suits.