Physicians’ views about health care costs are germane to pending policy reforms.
Objective
To assess physicians’ attitudes toward and perceived role in addressing health care costs.
Design, Setting, and Participants
A cross-sectional survey mailed in 2012 to 3897 US physicians randomly selected from the AMA Masterfile.
Main Outcomes and Measures
Enthusiasm for 17 cost-containment strategies and agreement with an 11-measure cost-consciousness scale.
Results
A total of 2556 physicians responded (response rate = 65%). Most believed that trial lawyers (60%), health insurance companies (59%), hospitals and health systems (56%), pharmaceutical and device manufacturers (56%), and patients (52%) have a “major responsibility” for reducing health care costs, whereas only 36% reported that practicing physicians have “major responsibility.” Most were “very enthusiastic” for “promoting continuity of care” (75%), “expanding access to quality and safety data” (51%), and “limiting access to expensive treatments with little net benefit” (51%) as a means of reducing health care costs. Few expressed enthusiasm for “eliminating fee-for-service payment models” (7%). Most physicians reported being “aware of the costs of the tests/treatments [they] recommend” (76%), agreed they should adhere to clinical guidelines that discourage the use of marginally beneficial care (79%), and agreed that they “should be solely devoted to individual patients’ best interests, even if that is expensive” (78%) and that “doctors need to take a more prominent role in limiting use of unnecessary tests” (89%). Most (85%) disagreed that they “should sometimes deny beneficial but costly services to certain patients because resources should go to other patients that need them more.” In multivariable logistic regression models testing associations with enthusiasm for key cost-containment strategies, having a salary plus bonus or salary-only compensation type was independently associated with enthusiasm for “eliminating fee for service” (salary plus bonus: odds ratio [OR], 3.3, 99% CI, 1.8-6.1; salary only: OR, 4.3, 99% CI, 2.2-8.5). In multivariable linear regression models, group or government practice setting (β = 0.87, 95% CI, 0.29 to 1.45,P = .004; and β = 0.99, 95% CI, 0.20 to 1.79,P = .01, respectively) and having a salary plus bonus compensation type (β = 0.82; 95% CI, 0.32 to 1.33;P = .002) were positively associated with cost-consciousness. Finding the “uncertainty involved in patient care disconcerting” was negatively associated with cost-consciousness (β = −1.95; 95% CI, −2.71 to −1.18;P < .001).
Conclusion and Relevance
In this survey about health care cost containment, US physicians reported having some responsibility to address health care costs in their practice and expressed general agreement about several quality initiatives to reduce cost but reported less enthusiasm for cost containment involving changes in payment models.
Near-death experiences represent for a medical school curricu lum a watershed area between life and death, between science and experience, and between the known and the unknown.First-year medical students as nascent scientists and clinicians have complex and often intense feelings about realms that are at the border zones of their developing acumen.In this context, the near-death experience is an ideal topic for teaching profession alism and respect for individual patients, differing cultures, and for colleagues who have differing sets of beliefs.Using videotaped presentations students were asked to explore their own and their peers' reactions to near-death experiences both in small group discussion format and using a web based discussion board.The inclusion of this topic early in medical school training was felt to be a valuable tool for developing both professionalism and collegiality.It also served to broaden the scientific viewpoint presented in the curriculum in a manner that promoted openness to and respect for patient perspective on life changing events.KEY WORDS: teaching; medical school; near-death experience.Near-death experiences (NDEs) are encountered by a substantial proportion of patients and families (Gallup and Proctor, 1982).Patients may turn to physicians for counsel after intense and confusing events that have affected their life views.Many physi cians are not equipped, or are unwilling, to provide support and
Functional medicine is an emergent field that combines traditional Western medicine, systems biology, and a deep understanding of biochemistry with a personalized precision approach to the individual in their sociocultural context. It believes that modifying upstream pathways and searching for root causes give better outcomes than care based on suppressing signs and symptoms of end-stage disease. Functional medicine practice uses specific tools and heuristics such as the Functional Medicine Matrix and Timeline to uncover relationships of presenting complaints to the underlying cellular level pathophysiology. The systems biology approach cuts across organ systems to find unifying biochemical and physiological imbalances that, when successfully treated, can prevent, arrest, and even ameliorate disease.
To assess US physicians’ attitudes towards using shared decision-making (SDM) to achieve cost containment.
Design
Cross-sectional mailed survey.
Setting
US medical practice.
Participants
3897 physicians were randomly selected from the AMA Physician Masterfile. Of these, 2556 completed the survey.
Main outcome measures
Level of enthusiasm for “Promoting better conversations with patients as a means of lowering healthcare costs”; degree of agreement with “Decision support tools that show costs would be helpful in my practice” and agreement with “should promoting SDM be legislated to control overall healthcare costs”.
Results
Of 2556 respondents (response rate (RR) 65%), two-thirds (67%) were ‘very enthusiastic’ about promoting SDM as a means of reducing healthcare costs. Most (70%) agreed decision support tools that show costs would be helpful in their practice, but only 24% agreed with legislating SDM to control costs. Compared with physicians with billing-only compensation, respondents with salary compensation were more likely to strongly agree that decision support tools showing costs would be helpful (OR 1.4; 95% CI 1.1 to 1.7). Primary care physicians (vs surgeons, OR 1.4; 95% CI 1.0 to 1.6) expressed more enthusiasm for SDM being legislated as a means to address healthcare costs.
Conclusions
Most US physicians express enthusiasm about using SDM to help contain costs. They believe decision support tools that show costs would be useful. Few agree that SDM should be legislated as a means to control healthcare costs.
Some clinicians have questioned the accuracy of rapid diagnosis of group A streptococcal pharyngitis by commercial immunochemical antigen test kits in the setting of recent streptococcal pharyngitis, believing that the false-positive rate was increased because of presumed antigen persistence.We studied 443 patients--211 cases--who had clinical pharyngitis diagnosed as group A beta-hemolytic streptococcus infection in the past 28 days and compared them with 232 control patients who had symptoms of pharyngitis but no recent diagnosis of streptococcal pharyngitis. Our aim was narrowly focused to compare the rapid strep test with the culture method we used in our clinical practice.We found that the rapid strep test in this setting showed no difference in specificity (0.96 vs 0.98); hence, the assertion that rapid antigen testing had higher false-positive rates in those with recent infection was not confirmed. We also found that in patients who had recent streptococcal pharyngitis, the rapid strep test appears to be more reliable (0.91 vs 0.70, P < .001) than in those patients who had not had recent streptococcal pharyngitis.The findings of this study indicate that the rapid strep test is both sensitive and specific in the setting of recent group A beta-hemolytic streptococcal pharyngitis, and its use might allow earlier treatment in this subgroup of patients.
