On the “doctor-patient relationship” split and a prisoner’s dilemma
A recent article in the Washington Post on the “doctor-patient relationship”, and Stanford University researchers have discovered a split in dichotomy of access and demands in the current healthcare system. Even with more expansion in coverage due to the Affordable Care Act, there is a distinct problem between practitioners and patients in priorities. Stanford researcher, Djulbegovic notes that doctors are under increasing pressure to to not only provide best care but be “good stewards of resources” as they are often “reimbursed” on how satisfied their patients are, as patients “fine-tune” their interests to the coverage they have.
The prisoner’s dilemma occurs when the facet of “keeping happy patients” to that of practitioners credibility and satisfaction ratings being judged on the service provided. The contention occurs where researchers used game theory to visualize the typical appointment between practitioner and patient, Djulbegovic and team astoundingly found that “42% treatment decision mistakes” were made due to conflict of interest. This situation of conflicted interest occurs with patients are under the mounting stress of shifting priorities for having to deal with increasing healthcare costs and overhead.
To where, patients are self-analyzing their conditions and demanding service for their perceived “need”, and doctors are corned into not providing “satisfactory” care based on patient surveys or expecting volatile health outcomes. Where in a scenario the prisoner’s dilemma models out to reflect Patient A) seeking pain-killers for having real pain, and the practitioner’s Response 1) is to treat the pain and prescribe the medication for rationality the patient is in pain Patient A) seeking pain-killers but faking pain Response 2) is to still provide the medication in “best intentions” and also fear for not receiving a positive review of practitioner care. The outcome of providing medication to the real and fake pain doesn’t directly harm anyone and ensures the positive review for the doctor and the medication for the patient, yet if a doctor decides to intercept at his own jurisdiction and not provide the medication for the fake pain– he is faced with receiving negative reviews and further overhead for “subpar service”. All in the effort that patients are bound to receiving the health care they deserve in lieu of high cost coverages and many still lacking adequate services for regular visitations.
This acknowledges the larger problem in our healthcare system of divided loyalty to the system of regulation or that of the patient’s “best interests”, which are both at disjunction in a large volume of cases. Calls for stricter regulation and alleviations in reimbursement reviews are creating a pipeline attempt at changing the current statute.
Sources:
http://onlinelibrary.wiley.com/doi/10.1111/eci.12380/abstract;jsessionid=7227CE2F4BEC80B9D5AAC3566B228728.f03t02
http://www.washingtonpost.com/news/wonkblog/wp/2015/09/16/how-the-doctor-patient-relationship-has-become-a-prisoners-dilemma/