‘Shopping for Doctors’

The matter of physicians’ fees and health-care costs is certainly a discussable and debatable subject. But I think you oversimplify and render your readers an injustice in your editorial (April 14), “Shopping for Doctors,” when you equate shopping for a doctor with shopping for a major purchase like a home or a car.

I imagine you can compare one automobile with another and make a decision based on price because machines are machines, wheel for wheel, engine for engine, gas consumption for gas consumption, color for color, etc.

There are so many variables among houses--condition, location, (landfill vs. solid ground), age, heating and so forth, I doubt you can make the decision to buy one on price alone.

Incidentally, it is not unethical for physicians to advertise fees. In this day and age, physicians can advertise as much as they want so long as their ads are not deceptive or misleading. I suggest physician advertising is merely unwise, simply counterproductive. Do you know anyone who became enamored of or even attracted to and chose a physician because of his advertising campaign?

Would you have a doctor replace an arthritic hip simply because his highly advertised fees are bargains?

You do indeed touch on some basic problems in the delivery of health care that involve fees. Patients must indeed overcome a prevailing reluctance to ask their doctors about their fees. Or anything else. Asking questions is not something patients are accustomed to doing. And answering questions is something many physicians are not much accustomed to either.

An awareness by patients of their responsibility for guarding their health when they are well, and for the need of their involvement in the health care they get when they are not well is vital. And so is the mutual advancement of forthright, meaningful and substantive communication between doctor and patient.

Patients must understand and appreciate their role as a partner of the physician and they must ask the questions they really want answered. And if their questions are important to them and satisfactory answers are not forthcoming, they should indeed shop for another doctor.

I suggest that patients should ask their friends or relatives, particularly those who have had the same medical problem they have, about their doctors. Did they like him/her? Did their doctor treat them, the patient, as well as he treated the disease? How were the fees?

It is certainly true that some fees are, or appear to be too high. Publishing a comparison price list will shed light on the range variation of fees. It might even move some fees, some down, some up. But such a list is indeed devoid of a vital and essential qualitative factor. It does not tell the patient which doctor is better at what, which doctor treats the patient as well as he treats the disease.

I was talking about fees with a physician friend of mine the other day, an orthopedic surgeon of impeccable credentials, a fine doctor, a wonderful guy. His regular fee for arthroscopic surgery of the knee, he said, is $2,000. Very conscious of and concerned with the cost of health care, he volunteered, “It’s high.” Then he thought for a moment and added, “You know, I do a lot of those operations for half that fee and a lot more for nothing.” Then he paused, thought for another moment, and said, “I think $2,000 is fair.”

Obviously, there’s a lot more to a physician’s fee than the numbers that follow the dollar sign.

MITCHELL S. KARLAN MD

Los Angeles

Karlan is president of the Los Angeles County Medical Assn.