Health Day has recently reported on a study regarding intuition:
“Doctor’s intuition that something is seriously wrong may have more diagnostic value than many symptoms and signs, the report suggested. Parental concern that a child's illness was differentthan normal was another strong influence on gut feeling, the study authorsnoted in a journal news release. A gutfeeling should prompt doctors to conduct a full and careful examination, seekadvice from a more experienced doctor, and advise parents what to do if theirchild's condition worsens, the researchers concluded.”
Doctor’s use experience as well as education to
treat patients. Medicine has always been
more of an art than a science. Today,
however, there is a push to make medicine a science, removing all subjective
processes from t he experience. It is a
push under the title of “Medical Necessity”.
Medical Necessity has been pushed by the government for the past few
years to have doctors use tests and past performances to treat a person. Now private insurers are jumping on the
bandwagon. United Healthcare recently
released a notice that it would implement Medical Necessity in inpatient care
beginning Oct. 1:
“As a reminder, Medical Necessity is the process for determining benefit coverage and/or provider payment for services, tests or procedures that are medically appropriate and cost-effective for the individual member. The Medical Necessity process is based upon a foundation of evidence-based medicine and:
· Provides an
opportunity to address covered services at the individual level to support
enhanced access to quality care for the member.
· Utilizes
generally accepted standards of good medical practice in the medical community.
· Offers timely
communication between health plans, members and providers to allow for
prospective, concurrent and retrospective review as well as appeal rights for
adverse determinations.
This foundation supports United Healthcare’s overall goals for providing enhanced access to quality care by raising performance standards and reducing variation in medical practice, and health care affordability by implementing a process that promotes efficient delivery of high-quality care in a cost-effective manner.”
What is important
to note in this missive is the sentence: “The Medical Necessity process is based
upon a foundation of evidence-based
medicine.” Evidence-based medicine
is defined as "treatment based on tests, labs and best medical practices for the
medical condition." The problem is that
diagnosing based on tests and labs is easy for the obvious conditions, such as
a broken arm or an ulcer, but as a doctor once remarked to me “you cannot see
pain on an x-ray”. In other words, not
all medical problems can be determined from a test or lab. There are many anecdotal examples of doctor’s
misdiagnosing or missing a serious problem, even with tests. This was brought to attention recently in an
article in the Daily Mail about a woman who died from undiagnosed cervical cancer.
If physicians will now only be paid for evidence
based medicine, then many diagnoses that are being paid for today - such as
chronic fatigue syndrome, depression, or low muscle tone, which cannot be
determined by a test but instead by direct observation and physician expertise -
will no longer be viable diagnoses. At
the end of the day, as much science as there is in medicine today, it is an art
and art cannot be measured.
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