Richard Smith: What’s bothering doctors?

Richard SmithThe fantasy that doctors are primarily concerned with patients and not much at all with money goes deep and is highly reassuring. Everybody was upset by two health ministers – Enoch Powell and Ken Clarke – observing that almost all of their conversations with doctors’ leaders were about money. But the evidence that doctors respond to financial incentives just like everybody else is very strong, and the recently published top 10 of what doctors (mostly American) read on Medscape in 2009 provides more evidence – as well as other insights into the concerns of doctors. The list is at the end of the blog.

Reassuringly the top item was clinical – swine flu. But on the same morning that I was emailed the Medscape list another email told me a group of European politicians have passed a motion arguing that the swine flu epidemic was a great scam cooked up by the drug industry. The argument is not that it didn’t happen but that its adverse effects were much exaggerated as were the supposed benefits of the vaccine and drugs. Many doctors take a similar view.

The next three on the list are all about money. Particularly distressing for American doctors is the growing idea that their levels of pay are “unsustainable,” but they probably are. I joke that the US will be the first empire to be brought down not by disease, as many have been, but by health care.
Three of the others on the list are to do with information technology. The US is the most technologically advanced country in the world – look at its military – but the IT in most doctors’ offices is primitive. Again it’s a matter of money.
Rather unfashionably American doctors are also bothered about “Noncompliant patients” and “No shows.” These concerns are also mostly about money.

The only surprise on the list is the other clinical item – “periodontal disease and the risk of cardiovascular disease.” I have two cynical hypotheses to explain this: it might have been the authors of the paper asking all of their friends to access the article, or, more likely, it’s dentists looking for evidence to support their growing hygiene businesses as the tooth filling business declines.

Top 10 most read articles of 2009 on Medscape

  1. H1N1 Influenza A (Swine Flu) Alert Center
  2. Solving the “Unsustainable” Physician-Pay Problem: Perspectives From the ACP, ACS, and ACC
  3. How Healthcare Reform Could Affect Physicians
  4. Doctors’ Recession-Buster Guide: Ten Effective Ways to Lower Your Overhead
  5. PDAs and Smartphones: Clinical Tools for Physicians
  6. Best Ways to Deal With Noncompliant Patients
  7. Best Ways to Deal With No-Shows
  8. Electronic Medical Record Survey Results: Medscape Exclusive Readers’ Choice
  9. No, Don’t Buy an EMR Now! Yes, Buy an EMR Now!
  10. Periodontal Disease and the Risk for Cardiovascular Disease

Richard Smith is a former editor of the BMJ.