To the Editor:
Re “In Medicine, the Power of No” (Economic Scene column, April 7):
David Leonhardt is right about the importance of reducing the use of health care services of limited or no value. The surest way to do that is for doctors and patients to build strong, trusting relationships and, then, for doctors to talk straight to their patients about what is best for them given the state of their health and the power of available treatments. Since we go to doctors for their expertise, it is reasonable to expect that we would accept their recommendations.
And there is the rub. Today’s insurers discourage doctors from spending enough time with patients to build those relationships. But, even when they exist, doctors are often reluctant to give “bad news.” And, finally, if patients don’t undergo the latest treatment, doctors lose the income from it, and the hospital will lose the income from the CT scan not ordered.
So, until these conditions change — including the nature of the incentives — those who say “no” are likely to be fairly rare.
Stephen M. Davidson
Boston, April 7, 2010
The writer is a professor at the Boston University School of Management and the author of “Still Broken: Understanding the U.S. Health Care System,” being published this month.
