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  3. I recently took care of a 50-year-old man who had been admitted to the hospi

I recently took care of a 50-year-old man who had been admitted to the hospi

游客2025-01-01  14
问题     I recently took care of a 50-year-old man who had been admitted to the hospital, short of breath. During his month-long stay he was seen by a hematologist, an endocrinologist, a kidney specialist, a podiatrist, two cardiologists, a cardiac electrophysiologist, an infectious-diseases specialist, a pulmonologist, an ear-nose-throat specialist, a urologist, a gastroenterologist, a neurologist, a nutritionist, a general surgeon, a thoracic surgeon and a pain specialist.
    He underwent 12 procedures, including cardiac catheterization, a pacemaker implant and a bone-marrow biopsy (to work-up chronic anemia).
    Despite this wearying schedule, he maintained an upbeat manner, walking the corridors daily with assistance to chat with nurses and physician assistants. When he was discharged, follow-up visits were scheduled for him with seven specialists.
    This man’s case, in which expert consultations sprouted with little rhyme, reason or coordination, reinforced a lesson I have learned many times since entering practice, in our health care system, where doctors are paid piecework for their services, if you have a slew of physicians and a willing patient, almost any sort of terrible excess can occur.
    Though accurate data is lacking, the overuse of services in health care probably cost hundreds of billions of dollars last year, out of the more than $2 trillion that Americans spent on health.
    Are we getting our money’s worth? Not according to the usual measures of public health. The United States ranks 45th in life expectancy, behind Bosnia and Jordan; near last, compared with other developed countries, in infant mortality; and in last place, according to the Commonwealth Fund, a healthcare research group, among major industrialized countries in healthcare quality, access and efficiency.
    And in the United States, regions that spend the most on healthcare appear to have higher mortality rates than regions that spend the least, perhaps because of increased hospitalization rates that result in more life-threatening errors and infections. It has been estimated that if the entire country spent the same as the lowest spending regions, the Medicare program alone could save about $40 billion a year.
    Overutilization is driven by many factors—" defensive" medicine by doctors trying to avoid lawsuits; patients’ demands; a pervading belief among doctors and patients that newer, more expensive technology is better.
    The most important factor, however, may be the perverse financial incentives of our current system.
    Overconsultation and overtesting have now become facts of the medical profession. The culture in practice is to grab patients and generate volume. "Medicine has become like everything else," a doctor told me recently. "Everything moves because of money. "
    Consider medical imaging. According to a federal commission, from 1999 to 2004 the growth in the volume of imaging services per Medicare patient far outstripped the growth of all other physician services. In 2004, the cost of imaging services was close to $100 billion, or an average of roughly $350 per person in the United States.
    Not long ago, I visited a friend—a cardiologist in his late 30s—at his office on Long Island to ask him about imaging in private practices.
    "When I started in practice, I wanted to do the right thing," he told me matter-of-factly. "A young woman would come in with palpitations. I’d tell her she was fine. But then I realized that she’d just go down the street to another physician and she’d order all the tests anyway: echocardiogram, stress test, Holter monitor—stuff she didn’t really need. Then she’d go around and tell her friends what a great doctor—a thorough doctor—the other cardiologist was.
    "I tried to practice ethical medicine, but it didn’t help. It didn’t pay, both from a financial and a reputation standpoint. "
    Last year, Congress approved steep reductions in Medicare payments for certain imaging services. Deeper cuts will almost certainly be forthcoming. This is good; unnecessary imaging is almost certainly taking place, leading to falsepositive results, unnecessary invasive procedures, more complications and so on.
    But the problem in medicine today is much larger than imaging. Doctors are doing too much testing and too many procedures, often for the sake of business. And patients, unfortunately, are paying the price.
    "The hospital is a great place to be when you are sick," a hospital executive told me recently. "But I don’t want my mother in here five minutes longer than she needs to be. "  [br] The causes of the overuse of medical examinations are all of the following EXCEPT that
选项 A、patients ask doctors to do more tests than necessary.
B、doctors want to make more money by using newer and more expensive technology.
C、doctors try to avoid being sued by their colleagues.
D、doctors want to prove to their patients they are competent.
答案 C
解析 细节题。第八段指出，医生给病人开过多的药是为了避免被起诉，这里是害怕被病人起诉，而不是被同事起诉，如果读文章认真的话，应该不难选出。从第八段里patients’ demands可以知道，病人会主动要求增加检验，故排除[A]。从倒数第二段最后两句话可以看出，[B]“医生会为了赚钱而对病人进行不必要的检验”也是致使过度医疗的原因，排除；在第十三段中，作者的医生朋友说，他意识到，如果自己不按病人的要求进行很多的检查，病人会去找别的医生，会夸赞自己的竞争者有多么棒。第十四段中，他的朋友还说这个不光是钱的问题，还关系到 名声的问题(both from a financial and a reputation standpoint)，为了证明自己是称职的医生，也会选择过度医疗检查，故排除[D]。  
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