Competing pressures put docs between a rock and a hard place

The pressures to reduce costs, avoid lawsuits and please patients increasingly put doctors between a rock and a hard place, according to a recent article from Medscape.

Just because a physician follows Choosing Wisely recommendations and avoids ordering an MRI for nonspecific back pain, for example, does not protect that doctor from a lawsuit for missing a diagnosis (the leading cause of liability suits).

The push to avoid unnecessary (and potentially harmful) interventions sometimes also puts physicians at odds with their patients' idea of good care. Refusing to prescribe antibiotics for a virus, for example, eats up valuable office time with unwelcome explanations and risks low scores on patient-satisfaction surveys, which can now tie into a portion of physicians' compensation.

The troubling contradictions end don't end there. "Along with the pressure to cut costs, there is the pressure to generate revenue [for hospitals]," Bruce Boissonnault, president of the Niagara Health Quality Coalition in Amherst, New York, told Medscape.

In the meantime, patients are financially responsible for greater proportions of their care, and eager to shop around for the best price, noted an article from the Miami Herald. Most of the cost-estimating tools currently available, however, reveal numbers more akin to a sticker price, rather than rates providers negotiated with insurance companies.

Nonetheless, physicians are more cost aware, according to Medscape. Chris Moriates, M.D., an assistant professor of medicine at the University of California at San Francisco, told Medscape teaches his residents to find out cost of services whenever possible and figure out how it will affect care. In some cases, Moriates added, this information can help improve patient compliance, as patients are more likely to fill prescriptions for more affordable medications.

In this time of multiple uncertainties in healthcare, there are no clear answers for physicians looking to reconcile it all, Jon C. Tilburt, M.D., a bioethicist at Mayo Clinic in Rochester, Minnesota, told Medscape. "Increasingly, the profession is under pressure to get rid of waste," he said. "It's unavoidable that physicians will be asked, 'How much bang you are getting for your buck?'"

To learn more:
- read the article from Medscape
- see the story from the Miami Herald