Tuesday, February 17, 2009

An Antiquated, Useless Right

Free patient choice of physician is an antiquated “right” that adds to cost, compromises quality, inhibits reform, and needs to be given up.

Last November, wife Marilyn and I both had medical episodes that involved hospitalizations. The bills that continue to dribble in are a reminder that between us we were probably served by something like a dozen physicians, if you count hospital-based specialties like radiology and anesthesiology.

Of that dozen, we “freely” chose only one – our primary care physician – and we first saw her at the suggestion of a neighbor when we moved to our current residence and needed to have a prescription written (she proved to be excellent!!).

We got Marilyn’s orthopedist some years ago when one of her knees needed attention and we called the hospital for a referral.

All the rest of the doctors we got because they were the ones on hospital duty at the time.

I have suggested before that in matters of health care, we need to learn to put our faith in institutions rather than in individuals. Actually, as our experience shows, we usually don’t have a lot of choice in the matter.

We ought to be able to believe that the hospital we choose has taken responsibility for the competence of any doctor related to it. In practice, we often do.

But here’s the problem. To the extent that we maintain and exercise the “right” to choose our own physicians, the hospital can get our business only by maintaining a relationship with the physicians we choose. That potentially puts the hospital in a bind. Severing the relationship with a marginally competent physician means losing the business the physician brings.

It shouldn’t be like that. Doctors ought to depend on hospitals for their patients rather than the other way round, and hospitals ought to be fully accountable for the competence of their physicians.

Of course, if a patient and a particular physician prove for some reason to be incompatible, the hospitals should without hesitation cooperate in arranging a change to a physician more suitable.

But the patient’s basic choice should be the hospital. That means forgetting about the increasingly useless “right” to choose our physicians.

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