We all pay price with doctors as salesmen
When you visit your doctor, your life is quite literally in their hands. Doctors, by degree and experience, are paid to render a service. This service by nature has a deep level of trust embedded in its delivery, which is bestowed on the doctor by the patient. It is a position of power built upon the implied level of standards, certifications and licensing required to practise their chosen profession.
Patients expect their care to be competent, trustworthy, ethical and appropriate. Healthcare consumers/patients make an appointment with their physician with an expectation that they will perform their duties to the best of their abilities to ensure proactive, healthy outcomes. It is always a better course of action to seek the advice of a medical professional than it is to self-diagnose via Dr Google or WebMD.
The business of healthcare delivery — make no mistake, it is a business — has changed dramatically over the years. Advancements in education, technology and ease of accessibility have opened the floodgates to what is possible to achieve within the comfort of your doctor’s office. From lab work to pharmaceuticals, diagnostic testing to diet supplements, medical specialists to cosmetic laser procedures, there are more options than ever before. Over the past ten years, Bermuda has witnessed an explosion of healthcare services popping up all over the island, but just because a medical professional can supply a service, it does not mean that they should.
In the United States and Britain, and many other countries around the globe, it is illegal for a general practitioner to operate many of the earlier-listed services out of their office owing to justifiable conflict-of-interest concerns. Like most professionals, physicians are also partially driven by the need to generate a profitable income.
On the surface, there is nothing wrong with this:
• 1, People need to make money
• 2, The ethical codes governing their profession act as safeguards against any potential greed and the exploitation of their patients
In reality, however, such assurances are not regulated for the medical community in Bermuda as they are for other professions such as law or accounting — you can hang up a shingle and call yourself a healthcare practitioner faster than you can sell hot dogs from a weenie cart on Front Street.
Some would argue that having additional services in a doctor’s office is a matter of convenience and practicality. Others may say: “What is wrong with a physician growing their scope of practice? It’s just business.”
However, therein lies the problem: it’s business, which can distract from delivering holistic, appropriate care based on what is best for the patient, and can quickly turn into what’s best for the physician’s profit margins.
Fact No 1: Bermuda spent more than $700 million on healthcare between April 5, 2015 and March 31, 2016 alone — we are second only to the US in overall healthcare expenditure.
Fact No 2: In general, the amount you pay to have insurance coverage has steadily increased. Nowadays, most consumers tend solely to blame their insurance providers for this without considering the role both the physician and the patient play in the overall cost of their premiums.
Fact No 3: Each year your insurance company sets the rates of the premiums that you will pay for the next year based upon its claims experience, meaning how often the members in your insured group claim on their policy and how catastrophic the claims are, which need to be paid for by the overall group insured. The healthier the insured group, the lower the premium. Conversely, if the group is unhealthy or is undergoing unnecessary procedures, the premium will rise.
This helps to explain the push from both the corporate sector and insurance carriers to provide wellness programmes in an effort to improve the overall health of their insured groups. Literally every person in Bermuda would benefit financially if we stayed healthier and used healthcare services less. As healthcare consumers, we all have a responsibility to ensure that we spend our healthcare dollars wisely. Frankly, it is going to take a village to get everyone on board.
More and more, people are beginning to work at being healthy. You can see this playing out with all the new gyms and health clubs coming online, the Government’s relentless push for us to all eat healthy, and of course, through the efforts of charities such as the Bermuda Heart Foundation, Bermuda Diabetes Association and Open Airways.
Now, I am not going to use this space to browbeat the medical community because there is enough blame to go around for the high cost of healthcare in Bermuda. However, before I go on, I would be doing everyone a disservice if I did not remind readers that prevention is always, always, always better than trying to find a cure. We as individuals — as consumers of the healthcare product — must take greater responsibility in managing our own health more effectively. We cannot continually point fingers and blame doctors, the hospital and the Government for our own lack of personal responsibility. You cannot live a sedentary life and mindlessly eat whatever you want and not expect to suffer the consequences. We all need to redefine what health is so that more people will participate in cost-saving prevention measures.
One of the challenges in Bermuda and around the world is that health has been turned into a mathematical equation that can cause grown men and women to shake at the thought of trying to make sustainable, healthy lifestyle changes. There is much confusion about what health actually is and how to obtain it, which leaves many vulnerable to the “medical salesman” in their search for the holy grail of health. It is in this confusion, and our reliance on medical professionals to guide us effectively, that too many patients become gullible to the overuse of “healthcare services”.
The “medical salesman” is looking to make a more considerable profit off both your insurance dollars and your ever-increasing copays. Once again, I am not disparaging the whole medical community; we are lucky to have as many good medical professionals on island as we do. As with all professions, however, there are outliers and exceptions to the norm, and medicine is no different.
Physicians can increase their profit margins in many ways by providing extra services such as in-house specialist referrals, quick-fix weight-loss gimmicks, lab testing and pharmaceuticals, to name a few. So how can you tell the difference between a “medical salesman” and a physician that genuinely is looking out for your best interests? How do you truly know that you’re getting the best value for the service that you and your insurance company are paying for? At what point should you begin to question your doctor’s intent?
It starts from your very first visit because you and your physician are in a partnership, and partners need to agree on the best way forward. Here are six things to note:
1, Asking savvy questions could help you to avoid unnecessary procedures and save you a lot of money
2, Don’t feel intimidated by the high-pressure sales pitch. Your physician is and has always been your employee; you paid them to provide a service. You are the CEO of your body, period; the captain of your health boat. Be empowered to take action
3, Avoid the upsell/self-referral. If you are sceptical about a certain procedure, ask your doctor if it is absolutely needed. Especially if the procedure is conveniently located in their office
4, Getting a second opinion from a different physician outside of your doctor’s office may reveal that all you need is some other minimal treatment option, saving you money, time and physical discomfort
5, Avoid the high cost of pharmacy dispensing and extra trips to your doctor’s office by asking for the maximum supply of your medicine
6, Ask if there are any conflicts of interest in any of the testing or medical support services you are referred to. The Institute of Medicine definition of conflict of interest is: “A conflict of interest is a set of circumstances that creates a risk that professional judgment or actions regarding a primary interest will be unduly influenced by a secondary interest.”
From diet green drinks to medical specialists, needless testing to under/overprescribing, unnecessary healthcare services come with a high cost both financially and personally when we are not smart, diligent and informative healthcare consumers.
Remember that your first and most important priority is your physical and mental wellness. I want you to proudly and unapologetically seize control of your own health because prevention is always better than searching for a cure.
There is no time like the present, and we cannot afford to reach a billion dollars in healthcare expenditure.
While it is easy to get stuck in a cycle of complacency about how your health is medically managed, it is no excuse to pay for what you do not really need.
Patients beware: when doctors become salesmen, we all pay the price.
• Simone Barton is the chief executive of the Bermuda Heart Foundation