Even though the overwhelming majority of physicians are honest and hard-working and make medical recommendations based only on their patients’ well-being, some doctors and hospitals allow their desire to turn a profit to interfere with good medical practices.
To learn more, Bottom Line/Health spoke with Evan S. Levine, MD, an internist and cardiologist at Montefiore Medical Center in New York City. Based on his 18 years’ experience as a physician and his extensive research in the area of unscrupulous medical practices, Dr. Levine advises medical consumers to beware of…
Example: You see an ad for an impressive new doctor who trained at the most prestigious institutions, but when you call to make an appointment, he/she is too busy to see you for six months. You get an appointment with his junior partner instead, and the big-name doctor has successfully attracted another patient to the hospital.
My advice: Do your research when looking for a new physician. Don’t rely on advertising to find one. Get referrals from a doctor you’ve seen for a long time (if you have one) and/or family members and friends whose judgment you trust. Schedule a “get acquainted” meeting with the doctor to make sure that you like his demeanor and overall treatment philosophy. (Your insurance provider may cover such a visit.)
Also helpful: If you are diagnosed with a serious illness, such as cancer or Parkinson’s disease, promptly see two physicians for an initial consultation — one who specializes in research on the condition and one involved in patient care.
This will greatly increase your odds of getting information on state-of-the-art treatments and the personal care you need. You can find a doctor who conducts research on a particular condition via an Internet search or by calling a local university-affiliated hospital and asking for such specialists.
Example: Computed tomography angiograms (CTAs), which examine blood flow in the arteries. This noninvasive test can be useful in determining the extent and severity of suspected or existing coronary artery disease.
But some doctors tell patients who don’t have heart disease symptoms, such as chest pain or shortness of breath, to get the test — even though the American College of Cardiology (ACC) does not recommend it in these cases.
The machine used to perform a CTA costs at least $1 million, so there’s a financial incentive for these doctors to recommend the test even when it’s not needed. Aside from the unnecessary expense for the patient, the radiation from this test is equivalent to having more than 100 chest X-rays.
My advice: Only a cardiologist should determine if you need a CTA, and it should be performed at an outpatient hospital center — not in his office.
To read the ACC’s guidelines for this test: Go to www.acc.org and click on “Quality and Science” then “Appropriate Use Criteria.”
Another red flag: Sonography machines in an internist’s office. Sonograms should be performed under the supervision of a cardiologist or radiologist. Internists don’t have the appropriate training.
Some hospital administrators pressure doctors to check out patients quickly, and some doctors may even get bonuses if their patients have short lengths of stay.
Where the danger is greatest: Beds in the intensive care unit (ICU) are far more costly than regular beds, so to make room, patients are sometimes sent out of the ICU too soon. If a loved one is moved from an ICU to an area with fewer monitors and nurses, it can be dangerous — or even deadly.
My advice: Speak up. If you think a loved one is too sick to leave the ICU or hospital, complain to the head nurse on the floor or to the hospital administrator or patient advocate. (Get the administrator’s or patient advocate’s phone number from the hospital’s operator.)
Oncologists are one of the few types of physicians who can sell medication in their offices in addition to prescribing it. To increase his bottom line, an oncologist could recommend pricey chemotherapy that won’t necessarily make you feel better or prolong your life.
My advice: If your doctor recommends a drug that he sells, ask if there are studies showing that the medication is more effective in treating your condition than other drugs.
If it’s chemotherapy, ask if research has shown that the treatment prolongs life. And seek a second opinion from another oncologist — preferably one based at an academic center.
My advice: For reliable doctor referrals, look for an internist you trust. When you find such an internist, stick with him. If your health insurance changes, it’s usually better to switch plans to stay with a good doctor — even if there’s a higher co-pay.
