Dr. Kussin: Doctors are Money-Primed! It’s Not Our Fault!

September 27th 2012   ·   0 Comments

By Dr. Steven A. Kussin, M.D., FACP

Over the last several weeks, I have written in The Utica Phoenix about the epidemic of over treatment and unnecessary testing . To pin down a reason for this excess, I wrote about defensive medicine, our fee for service system and greed .

But there’s another force at work. The math does not add up. Yes, we order tests to protect ourselves against litigation . Yes, we certainly like the money. But, I couldn’t indict raw greed as the primary reason we are profit driven. Just last week an article  noted that doctors in HMOs who don’t profit, still order CT scans. They order them with almost the same abandon as those who have a financial interest in getting you to sign up and then lie down for one.

No doubt there are some, and perhaps many, doctors who are cynical outliers who knowingly order tests that are not in your interest. And paraphrasing Lincoln, “all of us do it some of the time; some of us do it all of the time; none of us do it none of the time”. And yes, you should be aware of this and maintain an attitude of mannered skepticism in the face of medical advice. But the math does not add up.

So where is the wellspring, that continuous force, lying just below the surface that provides the stimulus for all the needless testing, invasions and prescribing?

Quoting from Luke.”The Force will be with you, always.”

It’s deep in our doctor psyches. It’s a behavior called money primed. Physics has been looking for a Unified Theory of Causality for a century. Einstein became lonely in his futile attempts to find it. Well, for medical economics I have found our Universal Theory of Medical Causality. Thank you, it was nothing really.

Priming is a concept that plays a key role in human behavior. There are stimuli, lurking in the background that never reach conscious awareness. Despite this, their presence influence what we do and why we do it. It could be just a word, a picture or even barely audible background music. They make an impression and alter our thoughts and deeds. For example, experimental participants were exposed to words that were evocative of kindness as part what they were told was a “language test.” When they subsequently made contact with a target subject, they viewed him as kinder than other participants who were not exposed to ‘kind words’. Kind words do make kind deeds.

Sometimes these priming stimuli don’t just pop up in our environments…they saturate them. And rather than just influencing our thoughts, they, in part, control them.

Enter Money-Primed
Money is an emotionally-charged subject that profoundly effects how live our lives and how we live with others. Above, I quoted Luke’s mission. No, not the Bible’s Luke. I’m talking the Star Wars Luke. But the Bible does weigh in. The New Testament 1 Timothy 6:10 says, “For the love of money is a root of all kinds of evil. Some people, eager for money, have wandered from the faith and pierced themselves with many griefs.”

Doctors are Money-Primed
Pre medical students worry about money and live in debt. Medical students hope for money and live in debt. Doctors-in-training earn very little money and live in debt. But all around them are their mentors, teachers and their seniors. These are the monied class that drive expensive cars, live in costly homes and go on extravagant vacations. Money, entitlement (and yes, wisdom) ooze from every pore.Money saturates our lives from our colleges to our clinics. And when it does, it changes how we see the world.

Time Is Money
In our fee-for-service world, time is money. And when people who work at ‘doctor level’ hourly wages get the time to think, they think about how valuable their time is. It’s been shown that “when people paid by the hour think about their time in terms of money, they are more likely to adopt an economic evaluation lens when making decisions.”

Earnest While Earning
And think about money we do. But we don’t do it consciously. Money-primed, we make subliminal decisions based on our economics. Even when ordering things that don’t help you, we money primed doctors could pass lie detector tests. We look earnest because we are earnest . Earnest while earning.

Money isn’t in our brains. It’s in the air we have breathed since college days. Our concepts of self are related to the economic evaluation of what our time is worth.

Kathleen Vohs, is a pioneer whose experiments revealed some of the traits of the money primed. She says, “Money has been said to change people’s motivation (mainly for the better) and their behavior toward others (mainly for the worse).”

Despite this, most doctors believe (really believe) that what counts are skills, advocacy and a pure intent, borne from our professional codes and ethical norms. And it’s true. It’s just that money gets in the way.

From the Boston Globe, ” As a mounting body of research is showing, wealth can actually change how we think and behave—and not for the better. Rich people have a harder time connecting with others, showing less empathy to the extent of dehumanizing those who are different from them. They are less charitable and generous. They are less likely to help someone in trouble. And they are more likely to defend an unfair status quo. If you think you’d behave differently in their place, meanwhile, you’re probably wrong: These aren’t just inherited traits, but developed ones. Money, in other words, changes who you are.”

When that test is ordered and you look into your doctor’s eyes you will see, reflected back at you, all the Hippocratic honesty that is also primed into us. It’s just that money gets in the way.

Next week…it’s your fault too, you know.

 

By Richard