Healthcare reform should not expect doctors to be saints

Atul Gawande (professor of surgery at Harvad, practicing physician and staff writer for the New Yorker) gave the commencement address to the University of Chicago Medical School. You should read the whole thing but here is his key point:

No one talks to you about money in medical school, or how decisions are really made. That may be because we’ve not thought carefully about what we really believe about money and how decisions should be made. But as you look across the spectrum of health care in the United States—across the almost threefold difference in the costs of care—you come to realize that we are witnessing a battle for the soul of American medicine. And as you become doctors today, I want you to know that you are our hope for how this battle will play out.

Earlier in the speech, he talks about some doctors who did make a difference:

He is a physician here in Chicago. He’d invested in an imaging center with his colleagues. But they found they were losing money. They had a meeting about what to do just a few weeks ago. The answer, they realized, was to order more imaging for their patients—to push the indications where they could. When he realized what he was being drawn to do by the structure he was in, he pulled out. He lost money. He angered his partners. But it was the right thing to do.
[...]
To insure that unnecessary costs are avoided ... surgeons agreed to do no operations on lung-cancer patients unless the pulmonologist and oncologist agree that it is indicated. This is radical. “I have had to swallow my ego repeatedly to stick to this principle,” he said. Sometimes he’s had to persuade them an operation was best. More often, however, they persuade him to drop his plan and with it the revenue. And he did—because it was the right thing to do.

In each case, the doctors had to fight the temptation that our health care system throws in their path -- incentives in our health care system that are stacked in favor of overtreatment.

Rather than hoping that every doctor becomes a saint, can we not change these incentives? Incentives in medicine should be oriented towards keeping patients healthy, not towards making hospitals and imaging centers profitable.