>I can give you one partial explanation: many US consumers equate healthcare quality with the number of tests, scans and expensive examinations they receive. As do ambulance chasing attorneys: if the physician leaves one box unticked, even if it wouldn't have changed care, it's cheaper for malpractice insurers to pay a bribe to avoid costly litigation both sides know won't succeed. The cost of this lawfare in the US is far more than the cost of malpractice insurance, if's also the forest of expensive wasteful investigations to avoid these antics. Plus many consumers consider that unless they consume more care than they pay in premiums, it's a bad deal. So they overuse, then complain that insurance costs more than the house fire insurance they'd never dream of using this way.
>
So, what are MD's accountable for?
Seem like "Heads I win, tails you lose."


>>>After leaving the corporate world, one of the first projects I undertook was inventorying replacement appliances at a huge apartment complex in NYC. One inventory system after another had failed.
>>>I was told that the people who would be using the system were building superintendents.
>>>I was also told that the purpose of the system was to reduce theft of appliances by building superintendents.
>>>decided to pass on that project.
>
>Seems to me a lot of industries have stock control/inventory systems used by the most likely thieves of product. Is this just another example that you can't expect what you don't inspect? Meaning unless the superintendent/store manager/warehouse supervisor knows there will be regular audit and full reckoning, there's no consequence to rorting any system? I'm not trying to tell you how your experience works, just wondering whether you could have played the genius by introducing the concept of regular stocktake!

You suggested that electronic med records seems to be causing more work than they save.
That's counter intuitive.
My point is that when systems that intuitively should be more efficient aren't - we need to look at what other factors might be at play.

Since I posted this, I happened to discuss it with a friend who has a family member who at one time was one of those nubile pharma reps who chatted with the MD while I cooled my heels in the office.

My friend told me that this rep's income was largely based on the number of prescriptions her MD's wrote for her products.

Not based on how well patients felt.
This rep's income increased in proportion to how sick people felt, or at least how sick MD's thought they felt.

And I thought the guys I met while working at Wall Street were messed up!