One of the benefits from focusing full time at Curadux on helping individuals get “just the healthcare they want” is that some of the motivations for delivering more care are more easily seen than during my years in clinical practice. Dr. John Mandrola is a Louisville-based electrophysiologist, who writes about medicine and healthcare in a winsome manner and has highlighted a hypothesis on a hidden cause of overuseby authors, Simler and Hanson.
Dr. Mandrola’s practice of electrophysiology (EP) within cardiology is one of the many technologic fields in medicine that has changed many lives for the better, typically by reducing the side-effect-filled medication regimens possible after EP ablation therapy is successful. Thus, he is not a therapeutic nihilist, rather a physician able to help many. He outlined in his Medscape Commentary of January 28, 2019 that he often thinks of the typical “suspects” in overuse: financial motivators of volume-based reimbursement, a focus on doing something rather than using watchful waiting, and simply willful ignorance of the facts by physicians.
His commentary then turns to a book, The Elephant in the Brain, by Simler and Hanson, that proposes a thesis that “hidden motives may be driving the desire to consume and deliver more medicine than is necessary to achieve health.” These authors use a framework of evolutionary biology to make their case that people act with selfish interests. One does not need evolution to explain selfishness, rather, as C.S. Lewis stated so clearly, pride is the great sin. Thus, theism can also be called upon to build a framework for human beings’ selfishness in consuming more healthcare than needed.
Mandrola concludes his commentary with an inference mirroring Simler and Hanson’s thesis: healthcare isn't just about health; it's also a grand signaling exercise calledconspicuous caring. The authors of The Elephant in the Brain go on to outline end of life care is particularly ripe for conspicuous caring signals. Mandrola’s commentary states:
“And nowhere is the signal of conspicuous caring better illustrated than in end-of-life care. While providing comfort care should put out a strong caring signal, the norm in our death-denial culture is that caring means providing and encouraging aggressive care—however futile.”
Those of us working to assure individuals receive just the care they desire now have one more motivation to consider as we align their values and goals with care received. It is solvable.