• Who’s got the power, doctors or patients?

    Is there any evidence about the relative amount of power of parties in the doctor-patient relationship? Yes, there is, from the work of Joshua Gans and Andrew Leigh. The answer should not surprise you.

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    • My patients have the power–and because I educate them–the information to make their own choices. Some of them decide that they don’t like what I have to say, and they seek other opinions. They seek other opinions because they correctly realize that the issue is not one of asymmetry between patient and physician, but variance among physicians. Asymmetry implies that there is indisputable knowledge that one party possesses. With the internet, it is not uncommon for patients to have more factual information than the physician.

      Krugman, please decide. If an idea is 50 years old and you like it, well, then why haven’t we learned the lesson? But if it’s 50 years old and you don’t like it, then some regressive is dragging us back to the days before the Civil Rights era, right?

    • After reading the study, here are some thoughts.

      The assumption is that patients do not care about week-end vs. week day, or that they at least prefer to avoid inauspicious days more than they prefer to avoid weekends.
      Also, they authors assume that is it physician preference and not hospitals policy that is the determinant for avoiding weekends. In my experience, hospitals are not staffed for elective procedures on weekends rand thus discourage or disallow elective elective procedures on weekends.
      Another factor not addressed, is the relative importance to the various parties of avoiding inaupicious days vs, avoiding weekends. Part of the negotiating would have to do with the strength of each individuals preference. (e.g. I won’t fight very hard for something that is only sort of important, and even less if the other party has a strong preference relative to mine.)

      Both of my children were induced–for different reasons. The first was on a Monday. This child was over due–and the decision was made to delay as long as medically reasonable to give nature its chance. The second was induced on a Friday–the specific timing included me wanting my husband to be able to be off work for the first few days in order to care for the older child. I can think of several other reasons why families would prefer to avoid weekend births.

      I do not doubt that physicians can be in a position of enhanced power when negotiating with patients—but I find this study unconvincing because of the weakness of its assumptions.

    • The interesting thing about the study is that it shows evidence of physician power in a case that Krugman wasn’t really arguing about. Pregnancy isn’t an acute medical condition – patients have plenty of time after pregnancy begins to shop around for a doctor who will meet their needs. If the patient as consumer hypothesis were true we’d expect doctor competition to all but eliminate deviation from patient preference.

      • Only in urban areas with lots of docs, maybe. In many areas of the country you have very limited or no real choice. Most OB docs, at least in my area, are all in groups. In smaller communities you will have only one or two groups. There is no reason fro them to compete on this issue since fees are set by insurance. You cannot charge a premium for a weekend delivery and on the other side the patient does not have the leverage to demand weekend delivery. Even in urban areas, if you have chosen to save money on your insurance by going with a cheaper plan, that will usually mean access is limited to very few docs.