INADEQUATE CARE: Expert Points Finger at Doctors

      The medical profession -- not managed care -- should be blamed "for most of today's health care problems," according to Mark Chassin, chair of the department of health policy at New York's Mount Sinai School of Medicine. During a speech Monday to business and health care professionals in Kingsport, VA, Chassin said that medical professionals are guilty of causing "quality problems in three categories -- overuse, underuse and misuse." At least 20% of health care provided to patients is overuse, exposing them to unwarranted risks, he said, adding that fee-for service payments and doctors' fears of malpractice lawsuits lead them to order unnecessary testing and treatments, such as "coronary angiography, hysterectomy, cardiac pacemakers and tympanostomy tubes as well as the prescribing of antibiotics, sedatives and tranquilizers." Chassin added that the uninsured and patients with coverage restrictions typically receive the opposite care; many are undertreated. Regarding cases where doctors make outright mistakes in treatment and medication, Chassin said, "Correcting misuse can boost health care quality as well as save money." He notes, however, that standards of quality will not be raised until patients push for action. "Too often, patients believe the health care they are receiving is excellent," when, in reality, it is subpar or even harmful, Chassin said. He concluded by recommending that medical professionals become "lifetime learners," saying, "Disease defeats us often enough. We shouldn't be defeating ourselves" with low quality care (Wilder, Times-News, 9/14).