You could die

I meant to come back to this earlier in the week but I got busy. Anyway, a few days ago I wrote about how health care is different than other products and services because it involves death. Make the wrong decision about your health care and, yes, you could die.

Avik Roy made a good point that death isn’t involved in all that many health care decisions. Sure. It is involved in the disproportionately high cost ones though. But there’s more.

Death is just the outcome we most fear. In certain situations, its immediacy and the incapacity that precedes it puts us at the mercy of physicians. Whatever the doc says while you’re in the ICU you’ll likely have done to you. Who knows how crucial it is? You’re in no position, nor are your loved ones, to do much comparison shopping.

But you’re at an extreme information disadvantage even when death isn’t immediate but you fear the possibility of a poor health outcome anyway. I recall taking each of my two daughters to the ER, one for dehydration from the flu, the other for respiratory issues we could not handle at home. In each case I consented to whatever the doctors recommended. It didn’t matter whether they were in immediate danger of dying. I did fear it, at least implicitly. But mostly I wanted my children to be more comfortable NOW. The doctors told me what they were suggesting would help. I trusted them. What else could I do?

I was faced with the same type of decision for myself this year. I had a strange symptom (no, I’m not divulging details) that could mean something serious or benign. Wanting to be efficient with my time and money (copays are not trivial), I did some internet research and asked a few doctor friends about it. I was told to see a specialist. So I did. Tests were ordered, including CT scans. I was advised that we should rule out all the possibilities, one by one. Who was I to argue? The whole process was inconvenient and expensive. In the end it came to nothing. Along the way I was not in immediate fear of my life, but I was concerned about my health. I went to the doctor for a reason. He’s the expert. I did what he recommended. Wouldn’t you?

If I had had to pay more for the care out of pocket that would have made the experience more financially painful, but I’d likely have made the same decisions. They’d just have cost me more. Sure, at some dollar value I’d forgo care. But then I’d be risking the bad outcomes I feared. This is the heart of the problem, isn’t it?

“steve2” (a frequent commenter of posts on this blog) wrote about our trust in physicians at the blog Alexandria,

When discussing medical care, many claim that it is no different than any other economic transaction. There is emotion involved when you buy a car they point out. You need to trust your lawyer. You can always, you should always, go shopping for the best results and best prices somewhere else. While these are generally true statements, I submit that medicine is different. From my ground-up view as a physician, parent, husband, consumer, friend and patient, it looks and feels much different. When I told that young wife that her husband might be paralyzed, she did not look like the spouses at the car dealer making a purchase. The immediacy and emotion of the young mother [over her ill child] did not seem like that when I go to see my lawyer, or when others see theirs. The elderly wife’s concerns [about her injured husband], that might seem trivial in some ways, misguided in others, represent what I actually see family and patients go through when making their health care decisions.

I don’t think it is wise to dismiss this notion or minimize it. When we’re in fear of bad health outcomes it is very hard to resist expert advice. We cannot easily distinguish whether that advice is worth the cost. Should the patient have to choose between health risk and financial risk? It doesn’t seem right. Where do we draw the line?

Health care may be similar in some respects to other goods and services. Yet, it is different and always will be, no matter how “consumer directed” we try to make it.

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