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  3. I recently took care of a 50-year-old man who had been admitted to the hospital short of breath. During his monthlong stay he wa

I recently took care of a 50-year-old man who had been admitted to the hospital short of breath. During his monthlong stay he wa

admin2009-08-13  68
问题     I recently took care of a 50-year-old man who had been admitted to the hospital short of breath. During his monthlong stay he was seen by a hematologist, an endocrinologist, a kidney specialist, a podiatrist, two cardiologists, a cardiac electrophysiologist, an infectious-diseases specialist, a pulmonologist, an ear-nose-throat specialist, a urologist, a gastroenterologist, a neurologist, a nutritionist, a general surgeon, a thoracic surgeon and a pain specialist.
    He underwent 12 procedures, including cardiac catheterization. a pacemaker implant and a bone-marrow biopsy (to work-up chronic anemia).
    Despite this wearying schedule, he maintained an upbeat manner, walking the corridors daily with assistance to chat with nurses and physician assistants. When he was discharged, follow-up visits were scheduled for him with seven specialists.
    This man’s case, in which expert consultations sprouted with little rhyme, reason or coordination, reinforced a lesson I have learned many times since entering practice: In our health care system, where doctors are paid piecework for their services, if you have a slew of physicians and a willing patient, almost any sort of terrible excess can occur.
    Though accurate data is lacking, the overuse of services in health care probably cost hundreds of billions of dollars last year, out of the more than $2 trillion that Americans spent on health.
    Are we getting our money’s worthy Not according to the usual measures of public health. The United States ranks 45th in life expectancy, behind Bosnia and Jordan, near last, compared with other developed countries, in infant mortality; and in last place, according to the Commonwealth Fund, a health-care research group, among major industrialized countries in health-care quality, access and efficiency.
    And in the United States, regions that spend the most on health care appear to have higher mortality rates than regions that spend the least, perhaps because of increased hospitalization rates that result in more life-threatening errors and infections. It has been estimated that if the entire country spent the same as the lowest spending regions, the Medicare program alone could save about $40 billion a year.
    Overutilization is driven by many factors—"defensive" medicine by doctors trying to avoid lawsuits; patients’ demands; a pervading belief among doctors and patients that newer, more expensive technology is better.
    The most important factor, however, may be the perverse financial incentives of our current system.
    Overconsultation and overtesting have now become facts of the medical profession. The culture in practice is to grab patients and generate volume. "Medicine has become like everything else," a doctor told me recently. "Everything moves because of money."
    Consider medical imaging. According to a federal commission, from 1999 to 2004 the growth in the volume of imaging services per Medicare patient far outstripped the growth of all other physician services. In 2004, the cost of imaging services was close to $100 billion, or an average of roughly $350 per person in the United States.
    Not long ago, I visited a friend—a cardiologist in his late 30s—at his office on Long Island to ask him about imaging in private practices.
    "When I started in practice, I wanted to do the right thing," he told me matter-of-factly. "A young woman would come in with palpitations. I’d tell her she was fine. But then I realized that she’d just go down the street to another physician and he’d order all the tests anyway: echocardiogram, stress test, Holter monitor—stuff she didn’t really need. Then she’d go around and tell her friends what a great doctor— a thorough doctor—the other cardiologist was.
    "I tried to practice ethical medicine, but it didn’t help. It didn’t pay, both from a financial and a reputation standpoint."
    Last year, Congress approved steep reductions in Medicare payments for certain imaging services. Deeper cuts will almost certainly be forthcoming. This is good; unnecessary imaging is almost certainly taking place, leading to false-positive results, unnecessary invasive procedures, more complications and so on.
    But the problem in medicine today is much larger than imaging. Doctors are doing too much testing and too many procedures, often for the sake of business. And patients, unfortunately, are paying the price.
    "The hospital is a great place to be when you are sick," a hospital executive told me recently. "But I don’t want my mother in here five minutes longer than she needs to be."
选项 A、There are a lot of excessive services in American hospitals.
B、Doctors are over-loaded in American hospitals.
C、American hospitals are suffering great losses because of poor health conditions.
D、The health-care service in the American hospitals is systematic and patient-oriented.
答案A
解析 本题是主旨题。前三段英文议论文中用anecdote(轶事)开篇，旨在引出作者真正的论点。论点在第四段中得到了阐述，即In our health care system... almost any sort of terrible excess can occur．Excess对应选项中的excessive。在第五段，“overuse”一词的使用．也对应了excessive，故答案为[A]。[B]中提到的医生负担过重在文中没有提及。只是在第三段里，提到了医生们是按劳计酬的，有一定的迷惑性，故排除[B]。[C]的内容前三段根本没有提及，故排除。[D]对美国的医疗系统赞誉有加，似乎是来自第四段的if you have a slew of physicians and a willing patient, almost any sort of terrible excess can occur．但是从“terrible excess”可以看出。作者并非在夸赞美国的医疗系统完善，对病人照顾周到，而是在阐述可能出现的过度医疗，故排除[D]。
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