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Comment by lifeplusplus | Hacker News Reader

I really love it when I want records from Doc A to be sent to Doc B, then the Doc B offices refuses to get records and insist the patient need to do it, despite signing over all the papers, and then Doc A refuses to send them because they can only give to patient - even though patient is begging to send them. Quadruple the pain if you need records from multiple doctors. This is why now I prefer going to chain hospitals like university clinics. At least they can access records from doctors within their network. Like NYU, Mount Sinai, Presbyterian, etc.

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My experience is that Doc A sends the thumbnail of the image to Doc B. Doc B is happy that Doc A sent an unusable file because he now gets to charge for a new image.

Hospitals track MRIs and other images ordered per doctor, and doctors are under pressure to hit their quota.

Not sure where you got the idea that there are "quotas" doctors have to meet for ordering diagnostic tests. I can't speak for other countries but in the US this is not the case.

Can confirm that in the "socialized" health care system of the UK, the "quota" is more like a "cap" and the optimization done is towards 0 not infinity.

You can't speak for other countries, but you can for all of the US? Then explain these articles:

"Doctors Under Pressure to Meet Quotas and Fill Hospital Beds" [1].

"Once hospitals have made such a huge investment, experts like Dr. Zietman say, doctors will be under pressure to guide patients toward proton therapy when a less costly alternative might suffice." [2]

"While payments vary widely, doctors often collect $500 to $700 for a typical M.R.I. done on an outpatient basis in this area." [3]

[1] https://www.thehealthlawfirm.com/blog/posts/doctors-under-pr...

[2] https://www.nytimes.com/2007/12/26/business/26proton.html

[3] https://www.nytimes.com/2004/03/13/business/an-mri-machine-f...

Article 1 is about certain for profit hospitals setting quotas on the number of patients doctors admitted to the hospital, and giving kickbacks to doctors for ordering tests (which is illegal).

Article 2 is addressing a cancer treatment, not diagnostic tests. And has one quote by a doctor concerned about oncologists being pressured to use proton therapy. No mention of quotas.

Article 3 is about the proliferation of advanced diagnostic imaging (MRI, CT, etc) in private clinics and the concerns about over utilization of these diagnostic tests as well as potential conflicts of interest with doctors having a financial stake in the tests they're ordering. These are both real problems in the US medical system. However, no mention of US hospitals placing quotas on diagnostic tests ordered by doctors on their staff.

Is it possible these types of quotas have occurred? Sure. But is this typical practice in the US? No.

> But is this typical practice in the US? No

Your experience is different from mine. Ordering unnecessary tests is typical practice in my experience. And doctors are quick to reject tests done at another hospital, as if tests done at another hospital are untrustworthy.

Any time a US hospital has expensive equipment, doctors working at the hospital are under pressure to keep it running. You can find any number of articles on this topic if you're willing to spend a few minutes googling.

It's definitely the case that many unnecessary tests are ordered. That is a different issue from quotas, which is specifically what I was addressing.

Anyway, I will concede that my personal experience practicing medicine is not necessarily representative of the practice of medicine in all areas of the country.

edit: grammar

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