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You Get What You Reward – Part One
It is intuitive to most of us that when you reward someone for a certain behavior, it is likely that they will continue that behavior. Reward hard work and you will get more of it. Reward shoddy work and you will get more of that.
Reward people who get good products and you will get more good products. Reward people who get poor products and then just “trying” is acceptable and society starts to decline.
Of course, many times paying people for inferior products is just frustrating rather than dangerous. If the mechanic doesn’t fix the bad starter on your car, the car might not start but you won’t die. If the toaster you bought doesn’t work, you just take it back and get another. These are irritating things that cost us time and sometimes money because someone didn’t produce a good product. However, in some areas of your life, an inferior product can be much more serious.
If you examine the way a product is rewarded, you will see that this principle applies in all areas of our lives. This is the first in a two part series discussing this principle applied to the practice of medicine. Next week we will apply this principle to the practices of the drug companies.
PRACTICE OF MEDICINE
First, while there is science behind certain areas in medicine, there are other areas which are just “theorized” and, as in other aspects of life, it often comes down to the skill of the practitioner.
Many of us have heard that the United States pays the most for medical care but often is rewarded with more medical problems than some other countries. Since this is the most prosperous country on Earth, even now, what explains this?
The answer is to look at what is being rewarded. A surgeon friend of mine told me that the way to select a surgeon is to find out not only if the surgeon has a successful track record with the type of operation that you need, but also to find out how quickly his or her patients recover after surgery and how many complications they have. The ones who have the fastest recovery rate and the least complications are the more skilled.
It would make sense that the more skilled surgeon should be rewarded more highly than the less skilled surgeon. What about other types of doctors? Do the doctors who actually locate and handle the cause of a patient’s complaints receive more compensation than a doctor who just prescribes a pill to treat a symptom? A reward for better performance by any doctor is rarely the case. Insurance companies, HMO’s and government insurance normally pay the same amount to the skilled and less skilled doctor. They reward the procedure and not the result. The majority of doctors are rewarded for “trying” but not for success. This is illogical because if the cause is found or the surgery is done right, then the insurers will have to pay less because the patient will not have to keep seeking medical help for the same situation.
The “practice” of medicine is complicated more because there is often no test that actually points to an exact handling of a medical problem. Often there is trial and error. The doctor has to try different treatments until they actually find a solution. While finding an actual solution is infinitely better for the patient and for society, these doctors are often not rewarded but instead are penalized.
Insurers refuse to pay for many of the tests necessary to properly diagnose a problem. Insurers will not pay more if the doctor spends an hour with the patient trying to really understand the patient’s problems, than if the doctor spends only five minutes. Finally, If these doctors find a solution to a problem for the patient or do the surgery right with no complications, then that patient doesn’t have to keep coming to see them and they lose the income from more office visits and procedures.
You see, insurers have decided that doctors are all the same and should be paid the same amount for an office visit if they spend 20 minutes talking to their patient or one minute. Many medical “consultants” are recommending that medical doctors average no more than seven minutes with each patient and say that since the compensation is the same for one minute or 300 minutes, it would be more profitable to reduce the time with patients even more.
If surgeons are paid the same amount for a procedure, then the ones that operate faster are rewarded more than the ones who may be more thorough and careful but take much longer. One surgeon I know said that insurers pay him the same amount for a procedure on the foot if it takes him four hours or eight hours, and if there are complications they pay him for handling those but nothing extra if the surgery solves the problem.
“What is rewarded? The answer is simple. Doctors who ask for the symptoms and prescribe a drug in the least amount of time are rewarded. Surgeons who operate more rapidly and can do more operations—regardless of their recovery rate or complications— are rewarded. Since this is the conduct we reward we should not be surprised that we are getting more and more of it.
There is a sizable percentage of symptoms that will ease and disappear in a few days even if you don’t see a doctor. However, giving some of the toxic prescription drugs can create other problems. Other symptoms are more serious. Our body is warning us that there is a problem. Like the signal from our car gauge that shows the engine is overheating, continuing to ignore the symptoms can create serious problems. Just masking the solution leads to more problems and makes as much sense as putting tape over the car gauge so you can’t see it. Both actions can lead to serious problems. Of course, it is easier to replace an engine than a body.
The obvious problem with this bureaucratic solution is that many of the complaints of patients could come from a number of physical causes. When is the last time that you went to a doctor, explained the symptoms that you were having and he or she asked:
What do you normally eat each day?
Have you been gaining or losing weight?
Do you drink caffeine either in coffee or soda?
Do you drink enough water with electrolytes to stay hydrated?
If you are employed, how many hours do you work and are there any stresses from work?
Do you have any emotional upsets or other problems that are bothering you?
Do you drink alcohol, use any narcotics or smoke marijuana and, if so, when and how much?
When do you go to bed and when do you normally get up?
If you can’t go to sleep what do you do?
What do you drink and eat after 6 pm?
When did you start having the symptoms that are bothering you?
As clearly as possible describe when do you have each symptom and as exactly as you can the symptoms and how they affect you when they occur?
Did anything in your life or habits or diet change just before you started feeling the symptoms?
Many alternative medical doctors ask these and many more questions, but few other doctors do. Since the above factors may be a cause or contributing cause for your symptoms, how can someone diagnose a medical problem without knowing the answers to these questions?
While there are no simple solutions, there are some common sense things that each of us can do. Here are some:
Take the list of questions above and type out the questions and answers to each and take the sheet with you to the doctor’s office and give it to the nurse so the doctor can see it before seeing you;
Demand that your doctor spend enough time with you that you can get his or her interpretation of your answers and enough time that you are confident that the doctor really understands your symptoms and has a logical plan to determine the cause(s). If after a reasonable time the problem is not handled, then find another doctor;
Speak with your employer, write your insurance company and your elected representatives and demand an insurance plan ,like the Health Savings plans, that allow you to determine which doctor you will see and negotiate the cost of your health care. Demand that insurers and the government actually reward doctors who get solutions;
Look for doctors that offer “Retainer Agreements” where you pay them an annual fee and can see them as often as you need for no additional fee. These doctors are rewarded if you stay healthy because if you have to continue to see them they receive no additional compensation;
Decide to be responsible for your health care. Research your symptoms. Find out which doctors have the best reputation for actually curing their patients and not just treating symptoms. If you have surgery, make sure that you find out the recovery period for the patients of these surgeons and how many complications they have.
If your doctor refuses to work with you as outlined here, then find a doctor that will. There is an increasing number of them. You can go on the internet and search under “alternative medical doctors” or “holistic medical doctors”. When you find them, call their office and find out if they will accept your approach of demanding a solution. If they do, then see them. If you find a doctor who really finds solutions, they are priceless and you should reward them by telling everyone that you know so that the doctor is rewarded for their approach.
At Novus, we invite people to ask of us the above questions and are delighted to have people read the success stories of our patients. We are proud of our protocols that allow people who had given up hope of ever getting off a drug find that they can do so safely and more comfortably than they ever dreamed. We believe that people who actively participate in any treatment always do better than someone who is directed like a sheep, so we always seek to involve our patients in their recovery.
Novus Medical Detox Center detoxes people from methadone addictions, OxyContin addictions, Vicodin addictions, and other opioid addictions as well as helps people withdraw from antidepressants and benzodiazepines and other psychoactive drugs. Please tell people on these psychoactive drugs that there is a solution at Novus.
NOTE: This information is provided for general educational purposes only and is not intended to constitute (i) medical advice or counseling, (ii) the practice of medicine, health care diagnosis or treatment, or (iii) the creation of a physician patient or clinical relationship. If you have or suspect that you have a medical problem or that this information may be useful to you or others, please consult with your health care provider before applying any information from our articles to your personal situation or to the personal situation of others.
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