In Sylmar, the emergency treatment waiting room at Olive View-UCLA Medical… (Los Angeles Times )
Re "Our big appetite for healthcare," Opinion, March 31
Dr. Daniel J. Stone mentions "the Starbucks syndrome in healthcare" when blaming the overutilization of resources on patient demand and doctor apathy. His solutions are accountable care organizations — networks of physicians, hospitals and patients working efficiently to keep costs down — and Choosing Wisely, which appears to be an altruistic approach to cost control. These solutions are doomed unless cost control is mandated from the top.
The U.S. Department of Veterans Affairs commands the lowest prices for drugs and other medical necessities. MRI scans in other countries cost a fraction of what they do here because the public is protected from usurious charges. In fact, the reason for our Medicare inflation is the lack of cost controls. What we need is improved Medicare with cost controls, and for everyone.
I personally do not care for Starbucks products, and the patients I see at the Venice Family Clinic cannot afford them.
Jerome P. Helman, M.D.
The expensive tests that Stone says patients too eagerly demand are often ordered by physicians without being requested. Moreover, hospitals inflate their prices for such tests.
Many patients, in fact, would decide on less care if only they were told about the improbabilities of success and the impacts on quality of life. One study has shown that physicians overestimate cancer survival by 27%. Another study showed that cancer patients are treated more aggressively in teaching hospitals regardless of the probability of success.
One cause of over-aggressive care is the reluctance of many physicians to raise the subject of end-of-life decision-making early enough to allow patients to make reasoned decisions. Instead, patients are often forced to hear the truth only when fear and panic overwhelm and confuse them.
It's wrong to blame patients for physicians' ordering of unnecessary or excessive diagnostic testing.
Bernard W. Freedman
The writer is a lawyer and bioethicist.
Stone writes that Angelenos "expect their CT scans, when they want them, in much the same way they expect their decaf caramel extra hot low-fat macchiatos." But as with any product, healthcare consumers want only what marketers convince them they need.
When a healthcare facility buys an MRI machine, they want a return on their expensive investment. To get that, they need to keep it scheduled, so they market their MRI services to doctors and patients. And patients are to blame for this?
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