Curse

You may not be a fans of Mozart and find no difference between a CD and live concert, but most of us would be more choosy when it comes to medical care.

What does a physician actually do in providing the "care" ? We take a history, perform a physical examination, perform tests, and spend time discussing our conclusion and plan of treatment with patients. The handicraft of medical care is all about personal concern.

Yes, we can increase our productivity by speeding up the clinic visit, working longer, or delegating part of our job to nurse practitioners and other trained persons. However, we are close to our limits because patients do not want shortcuts in their perceived care. In an attempt to further reduce the time of a clinic visit or hospital stay, it is actually very probable to cause more indiscriminate testing and referral.

What about advances in technology ? For many parts of economy and social system, that's a brilliant way to boost up productivity - but unfortunately not for medical care. In the contrary, advance in technology actually reduces productivity because our time - the limiting resource - is diverted to playing with computer records, doing cardiac catheterization, or other procedures. We have less time to take care of our patients.

That's the curse.

PS. I claim very little credit to the above discussion. Much of the argument was raised recently by Eric Neilson in his article Baumol's Curse on Medicine in the May 2008 issue of the Journal of American Society of Nephrology.