I recently came across a post detailing a trip to an emergency room. In this post, the patient’s family member was asking the blogosphere why they should they pay for medical services rendered if the diagnosis and resulting treatment was incorrect. Although I’m not a medical treatment personnel in any way, I believe I can address this issue.

Medicine is and always will be a practice. You don’t see doctors establishing medical service centers, they establish medical practices. So what does that mean? It means that no matter how much schooling, experience, or fancy equipment a doctor has, he is essentially still making an educated guess when it comes to diagnosing your illness. A doctor can never master medicine like a mathematician can master formulas, a doctor only practice the techniques of treating and diagnosing using the ever changing tools and techniques of his profession.

So why are you paying for someone to merely guess? A doctor’s guess isn’t as bad as it sounds, doctors have spent years in school learning to connect the dots between symptoms and illnesses. They have a wide variety of techniques and equipment to help them gather data unique to your situation in order to make a more educated and refined diagnosis. You are paying for the time and effort it takes to make a normal person into a fully equipped, stethoscope carrying doctor. Not to mention the medical supplies and lab tests used to diagnose and treat you. These things add up.

Is a doctor’s guess always right? Oh no, doctors make mistakes just like everyday people. The amount of mistakes and gravity of their mistakes depends on their training, experience, amount/quality data gathered from patient, and equipment/facilities available to them. Illnesses manifest themselves in many different ways in many different people. Some people have a higher tolerance of pain than others, so what seems like excruciating pain to one person, may only be a mild discomfort to another. Viruses, such as the cold virus, tend to mutate through out their existence bringing forth new symptoms and rendering older treatments ineffective. These constantly changing variables make it that much harder to diagnose and treat many illnesses accurately.

So now that we understand doctors a little more, lets take a look at the restrictions placed upon them by your insurance company. Its been established that doctors can only guess what ails you, but the more data the doctor has to analyze, the more accurate his diagnosis. Sometimes its necessary to conduct various lab tests in order to gain more data. These tests are expensive due to their complexity and materials needed, so your insurance usually covers them. However, since insurance companies want to prevent excessive spending, they will setup internal limits that limit the amount of services your insurance company will pay for. Most insurance policies detail the amount of in-patient days they will cover, the amount of medical lab exams a doctor can perform, etc. A doctor may have several ideas about your ailment, but if the insurance will only pay for 2 lab tests, he still might not have sufficient data if the tests are inconclusive. To make matters worse, if a doctor makes a diagnosis with this limited data, and gets it wrong he will be held responsible for any possible side effects of the resulting treatment. With the growing perplexity of illnesses, the escalating cost of equipment, and the limitations placed upon you by an insurance company, its tough out there as a doctor.

As far having to pay for the treatment prescribed by the incorrect diagnosis, I don’t really see what can be done about that. I know I wouldn’t purchase any medicine or equipment that has been opened or previously used to any degree. Eww.

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