About her own care, which she describes in JAMA, Nancy Kressin asks,
Why was I unable to negotiate a more conservative and less costly path for my own care? How could I, as a patient, have combated the forces driving the rush to diagnosis, or garnered more support for an empirical trial of medication to alleviate my symptoms and potentially illuminate their cause? Although I am a health services researcher and medical school faculty member and am aware of the issue of overdiagnosis—enough to question whether I really needed endoscopy immediately, or whether a few more days of watchful waiting with the changed medication dosing might suffice—I deferred to the clinician’s knowledge and experience, and scheduled the test, knowing my insurance would “cover it.” Had I realized in that moment that even with this coverage, several hundred dollars of out-of-pocket expenditures were in the offing, I may have protested further, but I didn’t have that information until after I underwent the procedure and received the insurance company’s “explanation of benefits.” There had been no discussion of the cost of the procedure with the clinician.
She points to some signs of hope in nascent and ongoing initiatives (PCORI, Choosing Wisely, etc.), but we have an awfully long way to go. In large part, there is just not enough up front discussion and planning. We’re too quick to test (and be tested) and to treat (and be treated) and too reluctant to talk (and ask questions). Yes, the incentives are wrong, but so is the culture.
The health system has been failing consumers too long. We can do better.
