I like the “sometimes”. In fact, that type of story is antecodatal evidence and the least reliable kind as an indicator of the behavior of a group.

It is undoubtedly true that some patient smay do that BUT the probability of it being more than 1-5% of patients would not be consistent with rationale behavior.

The general rule of human behavior is to prefer the least threatening or potentially ominous explaination for an event. To put it more simply,a patient will have an innate bias for preferring to hear that the headache is caused by a mild sinus infection rather than it is could be caused by a brain tumor.

From the personal perspective, I have both requested an MRI and argued that it wasn’t necessary.

In the latter instance, an ER physician insisted upon an MRI because of facial spasms that mimicked Bell’s Palsy in order to rule out a stroke. I aruged it wasn’t necessary as (1) my blood pressure was 100/58 and thus a stroke was highly improbable and (2) the supra spinatis tendon in my right shoulder had massive scar tissue from an injury which impinged two nerves and set off headaches and therefore the probability of facial spasms being triggered by the nerve damage was well over 90%. (And the MRI proved me right and I was extremely annoyed at having had to waste the time with the MRI when all I needed was some muscle relaxants and short-term pain medication.)

In the former instance, when Xrays did not show what was wrong in the right shoulder, my GP ask what I wanted to do. I said “Schedule an MRI if it will give a better view of soft tissue damage.” He did and I was correct as the MRI clearly showed tendonopathy of the supra spinatis. When then a course of treatment had to be determined, the GP ask what I wanted to do. I responded that I would just go home to the Cleveland Clinic so I didn’thave to fiddle about trying this or that wasting my time; and the Clinic could easily pin down the complete diagnosis, prognosis and course of care (which turned out to be a highly sophisticated chronic pain procedure that isn’t even performed by anyone in my state.) I should note that an HMO’s nonsense of referrals and approvals would have incurred more costs for them with ineffective and repetitive appointments with the GP and specialists “in network” who were not qualfied to treat, and wasted a LOT of my time as compared to my expeditious solution of the matter.

Only a hypochondriac ENJOYS and NEEDS the consant medical attention. The rest of the world prefers to spend as little time as possible in waiting rooms and being ordered about like mentally defective children by medical staff who presume the patient is incompetent to make a decision and has to have someone else decide for them and filter information. Most people have far better things to do with their time than sit and wait and keep coming back for appointments.

This idea that patients want more and more medical services simply because such services are available is nuts. Having to go through tests and procedures does not yield pleasure as does, for example, indulging in Creme Brulee or a trip to the Bahamas (and the consumption of these 2 items would vastly increase if the consumer bore no or little cost.)

PS: Any typs are the result of the marginal right shoulder/hand.

I agree, in part, with your closing observation that “preventing and managing serious illnesses are the real challenges in health care today and have the greatest impact on rising health care costs.” I would also like to see some of the ideas you put forward actually implemented more broadly (e.g., first dollar coverage for preventive care).

For better or worse, the biggest game in health insurance reform these days seems to be consumer-directed health care, and it’s not working all that well. HSAs haven’t taken off as expected, most people with HSAs don’t seem to use them to their highest potential (i.e., they delay care since it’s an out-of-pocket expense) and most physicians don’t take cost/source of payment/type of coverage into account when referring patients for diagnostic or other services, even though lower-cost alternatives are often equally effective (see other HealthBlawg posts re: CDH here).

Again, I agree that some changes may be necessary in order to get a handle on cost, but the law of unintended consequences is in full force when tinkering with health insurance mechanisms, and we must tread carefully . . . .

http://groups.google.com/group/fair-health