Think the US health system is better than the NHS because doctors order more tests? Think again...

[edamsavestheday]

The BMJ has been campaigning for greater transparency about relationships between pharmaceutical companies and doctors, and for pharmaceutical companies to publish all their trials, not just the positive ones.

Now they've got this re. the US - I've seen posters on NHS threads insist the US is better 'because doctors investigate more thoroughly' so thought this was interesting counter-argument:

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A personal view published today on bmj.com asks if patients can trust doctors who have ties with medical companies.
Emergency Physician Leana Wen, from George Washington University in the US, says that doctors should fully disclose any conflicts of interest to patients in order to build on patient trust. She says that due to her campaigning, she has become an “object of hatred”.
A recent study showed that “94% of American doctors have some relationship with a drug or medical device company” with other studies showing that these associations “skew research findings and doctors’ prescribing practices”. Wen says that doctors are expected to disclose this information to each other but not to patients, even though it is patients that are most affected.
She says doctors’ salaries often depend on the number of tests they order and procedures they perform with the Institute of Medicine estimating that “30% of all tests and treatments done are unnecessary, to the tune of $750bn every year”.
Wen asks whether “tests are being prescribed because it’s in [patients] best interest or because they benefit the doctor?”.
Research has shown that openness leads to more trust and better relationships, improved patient-physician communication and patient adherence to treatment recommendations.
Wen has met with conflict with other doctors saying that patients “can’t handle the truth”. But she believes it “should be up to patients to decide what is relevant to them when choosing a doctor and whether to follow that […] recommendation”.
She says that much more needs to be done and that “establishing trust is a critical part of care” and “at the core of what it means to be a doctor”.
She concludes that it should be compulsory for doctors to disclose how personal incentives could affect treatment and that her patients’ responses prove this, with one telling her “If you’re willing to be so vulnerable with me, I know I can trust you”.

[ohmymimi]

My American cousin (71) always seems to be having 'checks' and 'tests', including an annual endoscopy and colonoscopy under total anesthesia (no family medical history of problems either end). She recently decided her memory was not as it was and was whisked off for an MRI scan (all clear, unsurprisingly, as she still works full-time as an IT consultant and remembers far more detail than I do of our frequent chats). Medicine in the US is just a huge moneymaking industry.

As for the NHS, although I do the lovely annual bowel cancer smear test, following some recent troubles, which my Dr (and I) suspected was IBS. I was still fast-tracked to see a consultant. I then had all the tests leading to a colonoscopy and endoscopy at local hospitals in sharp sucsession (with minimum necessary anesthesia), as the consultant was not happy until all avenues had been covered (!). Optimum service. I had a similar prompt experience of very thorough investigation in 2012 following some breathlessness. I live in rural
Worcestershire.

[ohmymimi]

, not .after IBS

[edamsavestheday]

Glad to hear you had good, fast treatment ohmymimi.

Your US cousin's doctors have probably been able to pay their kids' college fees through that kind of unnecessary testing. General anaesthesia is not without risk to the patient but hey, as long as it is making money for the doctor or hospital...

[ohmymimi]

Thank you, edam, the NHS is not perfect I know, but my experiences have generally been good. (Which is more then I can say for the spelling and punctuation in my post, having re-read it!)

[niceguy2]

I'm sure certain parts of the American system are better than the NHS.

But I think for a nation, it's failing the country badly. Sure you can get more tests but only if you are insured, your insurance company agrees and the doctor could be motivated purely for the money.

At least with the NHS doctors decide purely on patient need. We also don't have millions of people with no access to healthcare unless it is an absolute emergency. And we don't see people bankrupt and destitute because they had the audacity to be ill whilst poor.

[slug]

It's like the old joke "What's the UK version of Breaking Bad? Guy gets cancer, gets treatment on the NHS. The end"

[dreamingbohemian]

"At least with the NHS doctors decide purely on patient need."

That's not really true though, is it? There are quotas and postcode lotteries and extremely long waits for tests even when, for example, cancer has been found.

I've read on here that GPs get bonuses for fitting Mirena coils, for example, isn't that a conflict of interest?

For a true comparison you would need to know how often tests should have been ordered under the NHS and weren't. But that's probably a lot harder to determine.

[niceguy2]

The NHS isn't perfect. Of course it's not. But I still think when you take the system as a whole, it's fairer than in the US where money seems to be the motivating factor and you have profit making companies making those decisions (ie. hospitals and insurance companies).

At least with the NHS it doesn't matter if you are rich/poor, you get put on the list for your test. I suspect if you had an urgent need you'd get bumped up the list faster.

No idea about GP bonuses, never heard of that one.

[dreamingbohemian]

But it is still about money with the NHS -- look at all the procedures they don't cover anymore, or the referrals they won't give, because they don't want to spend the money on it. That is not patient need, that is government budgeting.

If you can't get the health care you need, I'm not sure it's any better that it's the government vs the private sector making that determination.

I actually had better health care as a low-income person in the US than in the UK. It did cost me $100/month for the insurance, but then my taxes were much lower too (no council tax for example) so I think it evens out.

[ohmymimi]

Dreaming - which procedures and referrals do you mean? I can only speak from my own experience, but I have, nor anyone I know has ever been denied a referral or procedure. My cousin recently had both her arthritic knees replaced in a private hospital, under the NHS, as there was no NHS bed immediately available.

[ttosca]

No, never thought that.

[Winterwobbles]

Actually many people working in the nhs feel that too many tests and investigations are done here too - nothing to do with funding but simply to do with unnecessary tests can lead to more unnecessary tests, extra worry and more risk to patients. Any radiologist will tell you they try to minimise the risk of unnecessary scans - risk of causing cancer due to exposure to ionising radiation and tge fact that any test you do has a risk of showing an entirely normal/benign 'abnormality' that you then have to decide whether to investigate more invasively.
The reason we don't do routine colonoscopy on everyone in the uk to check for bowel cancer is that a cheaper, less invasive test gives a better result in terms of maximising true diagnosis and minimising risks like bowel perforation in an otherwise well patient.

[niceguy2]

Like I say, you can look at both systems and pick bits out that are better or worse to try and prove the point you wish to make.

But taken as a whole I think the NHS system is fairer to all.

With regards to procedures no longer covered or referals they won't give. I'm curious as to what you are thinking of.

I think nowadays we also have to be mindful that often people self diagnose on the Internet. So they may have a cold but through Google and forums they're convinced it's the bubonic plague. Then when the doctor refuses to refer them. Is that rationing or a doctor making a sensible clinical decision? Probably the latter but some patients may feel differently.

[edamsavestheday]

Winter, indeed, it's always a balance between the risk of the test/investigation v. the risk of not finding out something that could be important. But in the NHS, at least the decision-making does not turn on 'how much money can I personally make out of this patient, no matter what harm I might do them in the process'.

Dreaming - the NHS is far more about patient need than the US system, which is about maximising profit.

The NHS isn't perfect - no system is. But it has the best access in the world. No-one is turned away for lack of money. Ever.

And the treatments that are denied are often things that aren't of any particular benefit to the patient. Not entirely, but often. Some PCTs (before they were abolished) were far too strict on e.g. grommets which they saw as an easy cut. But overall, the NHS is a thousand thousand thousand times better than the US. (Which isn't hard, to be fair, the US has the most expensive health system in the world for the worst outcomes of any developed nation, last time I checked.)

[zelda200]

In case anyone's still following: if in doubt about US healthcare system, you can watch the Michael Moore documentary "Sicko" for free here: topdocumentaryfilms.com/sicko/

Pretty incendiary stuff. The NHA party - nhap.org - are fighting for the NHS, to stop it becoming like the US system. They're fielding candidates in the general election, perhaps in your constituency?