Mon, Jul 14, 2014 - Page 8 News List

Doctors deserve reasonable return

By Skye Hung-chun Cheng 鄭鴻鈞

Taiwanese lawyers receive NT$10,000 per hour in consultation fees, while diagnostic fees for doctors are just NT$250 — a sum that is often reduced according to the total cost of each visit.

When you send a car off for maintenance, it takes at least half an hour. Humans are far more complex than cars, so how can doctors be expected to give accurate diagnoses of serious illnesses in two to three minutes?

Two weeks ago, a woman came to see me. She had been diagnosed with stage 1 breast cancer in 2005 and had been in good health after finishing treatment. In March last year, it was discovered that her Cancer Antigen 15-3 (CA15-3), a marker used to monitor particular types of cancer, had risen. As a result, her attending physician booked her for a lung CT scan, which found a small nodule. In December last year, she had another lung CT scan, which showed that the tiny nodule was still there and had not changed in size. In May, her attending physician scheduled her for a positron emission tomography (PET) scan, which showed the nodule had gone.

However, her physician was still worried and recommended that she get a computer-aided fine-needle aspiration biopsy done on her lungs. However, she was worried about this and came to see me for a second opinion.

I spent an hour with her, going over the progression of her breast cancer, her treatments and her scan results. This is when it became apparent to me that her case was a typical example of the overuse and misuse of certain kinds of medical treatment that is so common in modern medicine, as well as indicative of the failure of preventative medicine.

First, CA15-3 has never been viewed as a necessary follow-up to breast cancer treatment, especially as this patient completed treatment eight years ago.

Second, a single lung CT scan is equivalent to 100 X-rays, while a single PET scan is equivalent to 200 X-rays. So, within the short space of 15 months, this patient was exposed to amounts of radiation equivalent to 400 X-rays. In addition, she had to go through the mental anguish of being told the cancer may have returned.

Did this patient receive good medical care? She had a lot of expensive tests done, but she did not have to pay for them out of her own pocket, as they were fully covered by the National Health Insurance (NHI).

Her original attending physician is well-known in Taiwan and attends to about 60 or 70 patients per shift. Due to time constraints and the worry this causes that some important problem may be overlooked, many tests are necessary to make up for the lack of time spent one-on-one with patients.

The design of the NHI means that doctors make money whenever tests are performed. Patients often feel more satisfied the more tests they receive. I spent an hour with the patient I have mentioned here, to understand her medical history and compare the very small differences between her numerous scans.

For this, the NHI paid me only NT$250 in diagnostic fees.

It is only natural that as time goes by, fewer potential physicians will be interested in performing such hard work for such little return.

The current problem in the nation’s medical industry — a lack of skilled professionals in internal medicine, external medicine, pediatrics, obstetrics and gynecology, emergency departments and anesthesia departments — is the result of this.

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