Tuesday, August 25, 2009

Doctors Are Like Car Mechanics

Doctors are like car mechanics in that we give them so much power over us. They control the course of our healthcare, and in the same way that we have to trust the mechanic's diagnosis of our car, we trust doctors because we don't know enough about diseases or staying healthy. That's the subject of NPR's Planet Money's recent podcast. People trust their doctors when they recommend certain tests and procedures, which is why fee for service isn't necessarily the best thing for the patient or our health care system. If doctors are motivated by money, they'll perform unnecessary tests and recommend unnecessary procedures.

But if you're like me, you don't like car mechanics or doctors and you avoid both at all costs. I do regular maintenance on my car and the same for my body, I eat well and exercise, and avoid over the counter or prescription medicines. I realize I'm fortunate that I can avoid doctors because I don't have any existing health problems.
KESTENBAUM: That's right. Your doctor is an auto mechanic because, because of this one big issue that you don't get with the mom or the street salesman - the information problem.

JOFFE-WALT: The information problem. For example, the other day this guy comes into Ari's shop, good guy, he's got a Buick. He tells him, every time I step on the brakes, the entire steering wheel, the whole thing in the car shakes. And Ari says, oh, no problem, really simple. Three hundred and twenty-dollar fix. But then...

Mr. COHEN: And we checked a little bit more into it and we find out that the wheel bearings have some play and the axle's out of balance. They bent or the shaft is not aligned right.

JOFFE-WALT: And how much more is that going to cost?

Mr. COHEN: It varies on the car, but like on a Buick, the wheeling bearings, they a little bit expensive, so it can be like another thousand dollars.

KESTENBAUM: We've all been in this situation. You take the car in, Ari's a good guy, but you don't really know. We as customers, we have an information problem.

It's the same with health care. Patients can't always judge whether we need surgery. We don't know what procedures are necessary and which aren't. And doctors, they don't always know what drugs or what treatment works best.

JOFFE-WALT: And this is why when you hear proposals for how to fix health care, you hear talk about changing how doctors are paid, or that we need more research so you don't have these information problems. So the doctor is in this strange spot and unfortunately that is not the only strange thing in this market. You are strange. Read the rest or listen.