Patients distrusting doctors is bad economics
The biggest cost to patients is also the doctor’s most reliable diagnostic tool kit—tests, follow-ups, interventions
In 1999, I returned to India from the US to avoid a pervasive, dangerous phenomenon in American healthcare – defensive medicine. Basically, rather than using clinical acumen, it had become common to order diagnostic testing or just refer a patient to a specialist. This helped in avoiding potential legal claims, especially when the financial burden was someone else’s. So, why change anything?
Many years later, my fears have been confirmed, and I recognise that most of this results from the dubious atmosphere that exists when patients mistrust doctors. Recently, two Gurgaon doctors were arrested on charges of ‘medical negligence’ and paraded on the front page of every prominent news outlet. While personally this evoked a sharp visceral reaction, it also seemed highly likely that such incidents would encourage Indian doctors to start playing defensive, too.
Current trends show that 70-80% patients pay for healthcare as an out-of-pocket expense. The biggest cost to patients unfortunately is also the doctor’s most reliable diagnostic tool kit – tests, follow-ups, interventions, etc. When a doctor suggests investigative tests, a reluctance to spend comes up at the patient’s end, backed by the worry that tests have been ordered for profit. So they decide to go with the popular ‘second opinion’ option, followed by a third, and a fourth, ad nauseam. There is a genuine belief on the patient’s end that doctors are acting in corporate or personal interest, and extorting money. It doesn’t help that today’s hospitals use high-end technology, which does not come cheap. In addition, star doctors do indeed have to justify their own and their team’s salaries. That said, painting doctors in broad contemptuous brush strokes wreaks havoc on how we’re able to offer care.
Repeated, scattered consultations are undoubtedly harmful personally to a patient and their financial distress, but it’s just as poisonous for the entire healthcare food chain. The system may be flooded with short-term gains, but the victory is incredibly pyrrhic, as the long-term damage to the ecosystem is devastating. We end up with a dynamic wherein patients mistrust doctors because of the myriad solutions they’ve received over multiple consultations, and doctors who play it safe and pander to this trend. This may be an unpopular opinion, but I have real nostalgia for the time when there was one family GP to address each health concern and his word was sacrosanct. The need to refer to a specialist was far and few in between.
Normatively, hospitals are an interplay of clinical care and best outcomes, delivered at the lowest cost. Theoretically, a well-run hospital can deliver decent profits. This is dependent on rational pricing and constrained operational costs and, of course, not spending excessive money on frills in infrastructure. This patient-doctor fissure is creating more costs in delivery, more per-unit usage drugs, consumables and radiology testing. The overall costs escalate and someone’s paying....
I’ve laid out the problems and would be hugely remiss if I didn’t offer solutions. One, governing bodies. Doctors professional bodies, let’s self-regulate, credential transparent pricing and work on patient-friendly packages with digitisation at the core. Moving onto patients, we need to realise that we live in the times of WebMD, we doctors are no longer seen as the sole source of medical gyaan - there will be cross-questioning.
As a result, our approach to our patients needs to adapt, too, because chances are they’ve pulled up Google as soon as they’re out the door. The sooner we regain this trust, the sooner we collectively start to bring down healthcare costs. Ultimately, medicine does have elements of art and nobody can predict outcomes all the time, but we need to prevent this slide into bad healthcare economics. An ounce of prevention is worth a pound of cure.
Amit Varma is co-founder of Quadria Capital, one of Asia’s largest healthcare private equity firms.