The value of expertise–a recurring theme

January 2, 2018 - Posted by: admin - In category:

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The cost of screws and a metal plate is not the proper test of value for a surgical procedure. 

This is not a new subject. Rather, it is a repeated theme.  There seems to be a common disconnect between experience and expertise on the one hand and price and value on the other hand–at least in the minds of some people dealing with professionals, other than medical professionals.  Such is consistent with my overall experience working as an attorney for almost two decades.  I normally don’t see the same disconnect when it comes to physicians, dentists, and related healthcare professionals. Rather, I have found that more often than not, people “value” the training and expertise of their medical service providers. However, I was recently surprised to read a letter to the editor in a local paper which exhibited the same disconnect concerning the submitter’s surgical procedure.  This was something I did not expect.

The letter to the editor mentioned was from a patient who had recently had an operation on his leg.  During that procedure, a few screws and a metal plate had been inserted into the patient’s leg to stabilize a broken bone. He was complaining about the bills he had received following his surgery. Further, he was using as a standard for measuring the unreasonableness of his bills the divergence between the price he would pay to purchase some screws and metal from the hardware store vs. what the surgeon and hospital were asking him to pay for his surgery.  In other words, he seemed to disregard the value of such things as: (a) the surgeon’s education, experience, and skill; (b) the anesthesiologist, the nurses and others who assisted with the surgery and (c) the hospital facility and all else that is related thereto.

Was this person REALLY of the belief that there was no value whatsoever in the surgeon and those other things above and beyond the cost of the hardware? No, I think that this person understood there was some measure of value in such things. Would this gentleman, if given a choice, preferred to have his neighbor insert the screws and metal plate via a procedure performed in his basement, using his drill and wood-working tools? Again, I am confident the answer is no.

Even so, this individual seemed to be upset. He wanted to get people to read and react to his letter in the paper. He, therefore, took the extreme measure of comparing things which are incomparable.  However, the fact that this letter was even published by the paper gives me cause for concern.  A person with such a mindset seems unable or willing to pay a fair price for expertise and experience. Perhaps the “magic” of Google and other internet resources are causing some folks to move towards a narrow and misguided mindset, even when it comes to healthcare and related services.

Am I saying that healthcare costs, in general, are not a real problem? No, I am not saying that.  We all know that the opposite is true–the continuing exponential increases in the costs of healthcare (including healthcare insurance) are a significant problem we all face.  Even so, challenges are best solved with rational minds and reasonable approaches.  Even if the author of the letter to the editor did not really believe all that he was espousing (i.e., it was more of a publicity grab), the problem with making such public declarations is that invariably, others will grab onto, believe and later adopt such viewpoints (even if far-fetched and divorced from prudent thinking).

I obviously support the premise that there is actual and quantifiable value in professional training, experience, and expertise. Otherwise, I would need to find a new way to make a living–and so would just about every professional, be it doctors, dentists, engineers, mechanics, accountants, financial advisors, real estate agents, bankers, mortgage brokers, appraisers, architects and pretty much everyone else who is paid to think and otherwise do something with their brain, rather than just producing things on an assembly line.  Reference here that story about the old man who knew how to tap his hammer in just the right place and just the right manner to fix an engine that propelled a VERY expensive vessel.  In that story, the cost of the hammer was small and the amount of time spent by the old man in solving the problem and the repair was short–yet the value given was immense.

If we simply equate time spent on a task with value, then we are asking for a world of nothing other than hourly wage workers. Afterall, if value equates only to time spent on the current task (and cost of materials used), where do we account for education, experience, and old-fashion know-how?  But, you may say, such things are to be factored in via the difference in hourly rate.  For example, a teenager doing yard work should receive a much lower hourly fee than a brain surgeon (to use the extreme example). That is certainly one way to approach the whole value-given/received determination. Even so, that approach is still flawed, in my view.  Using the brain surgeon example further, consider a situation where the skilled and very experienced neurosurgeon is able to diagnose and recommend life-saving treatment for a patient in a manner of 5 minutes. Would it be reasonable (or even remotely rational) for the person whose life was thereby saved (or a family member of the same) to later insist that the doctor had spent only 5 minutes and $2 worth of medical supplies in such process and therefore the medical bill should not be more than $25 or $30? Again, the “time spent on the task equates directly to value received” approach is flawed and problematic on a number of fronts.

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