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    How can doctors cure America’s ‘sickness’?

    In her new book, "An American Sickness: How Healthcare Became Big Business and How You Can Take it Back,” Elisabeth Rosenthal, MD, takes a clinical approach to examining the current state of healthcare and the proper treatment plan to fix its ills.

    To analyze the complex challenges facing healthcare today, Rosenthal traces the evolution of the problems with the healthcare system—from insurance to hospitals to the rising prices of pharmaceuticals—while also offering some solutions.Elisabeth Rosenthal, MD

    Rosenthal recently spoke with Medical Economics to discuss the book, including how physicians shaped the chapters and can enact change going forward.

     Medical Economics: Discuss your interactions with physicians for the book. What is their level of frustration with the American health system?


    Hot topic: Hospitalists, PCPs bad communication hurts patient care


    Elisabeth Rosenthal: Important to [physicians] was feeling a loss of control over the values of medicine they thought were really important to them in deciding to become a physician. They are frustrated with the time spent on the bureaucracy of medicine versus time with patients, which is why people went into medicine instead of other professions that would have paid well. The feeling like, in the past, you could do the right thing for your patient, but now it’s much harder—that’s the frustration.

    Another common theme I heard again and again was they did not control pricing and had no way to control it. So their patients come back and say, “Hey doc, thanks for taking out my appendix, but I got a $40,000 hospital bill I can’t afford.”

    Any caring physician feels really bad about that and they get the brunt of that frustration, and it doesn’t make you feel good that you helped someone and then bankrupted them. That wasn’t their intention in becoming a doctor.

    So I think there was a sense that we were paying out a lot of money in our system for things that really didn’t involve medical care [in the hospital bill outside of the cost of the actual surgery], which they saw—and I see—as the real focus of “value.” That’s what medicine should be about: the care.


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     ME: And a lot of what physicians are doing is uncompensated, such as checking online for the best prescription drug prices.


    ER: Neither patients nor physicians asked to be put in this “consumer-y” healthcare world, where I, as a patient, have to shop around for a knee replacement. I didn’t ask for that, I just need my knee replaced. And physicians are in a similar situation. They have to send patients for an MRI. They often have no idea what their hospital will charge for that MRI and they have no control over it, and it’s only after [the procedure] they find out the cost because the patient complains about the bill. The doctor hates that. 


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