Wednesday, April 1, 2009

Does the Medical Treatment I Get Depend on What Community I live In?

Geography is often destiny when it comes to medical care. That might not seem the most intuitive conclusion, but a study by the NC Health Access Coalition seems to bear it out. In Morganton NC, for example, patients are 1.5 times more likely to undergo bypass surgery than patients who live only 22 miles to the west in Hickory. Morgantonians are also twice as likely to undergo cardiac bypass surgery as are residents of nearby Rutherfordton. That is one of the more mild discrepancies in the study (which you can read by clicking the title of this post) whose main points are:

1.) That surgical rates vary widely across neighboring communities in North Carolina.

2.) Poverty levels, diagnosis and the availability of medical care have been ruled out as explanations for the variation.

3.) Physician preference is driving care even when multiple, valid treatment options exist for a given diagnosis.

4.) NC could save millions and operate a more patient-centered model of healthcare if it would study and limit the variation.

So, are physicians trying to keep patients from getting the treatment they prefer? Not exactly, but look at it from the view of the doctor. In your career, especially as a specialist, you'll see many patients who have the same condition, for which there will be many treatment options. Sometimes empirical evidence may indicate one treatment better than the others but, all things equal, it would be easier to perfect one course of action. Over time doctors end up preferring the treatment with which they're most familiar.

Nor surprisingly, patient's tend to shy away from expensive and invasive procedures. Doctor's however, push for more aggressive intervention into disease. The doctor of course knows best and in many cases he opts for that route because it is the surest way to achieve optimum health. But it also detracts from the patient being the one at the center of the choice about medical care. At least, this is afar more likely scenario than Fayetteville citizens preferring or requiring endarterectomies six times as much as their counterparts in Durham.
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