It's politically correct to start with the assumption that we are the best at everything and, when it comes to medicine, we are the world leaders. We spend more money on our healthcare than any other country. Yet, when you compare us to all these other countries, we consistently underperform. Our health system does not give value for the dollars we spend. Whatever the measure, whether for quality of care, efficiency in delivery, access to care services, fairness in deciding which patients are allocated resources, or the quality of life after treatment, the US comes way down the international lists. You can, of course, dismiss comparative lists. There's always a lot of politics involved in deciding how to collect and analyze the information. Other countries have a point to prove by showing the US as providing a standard of care that would not be tolerated in third world countries. Yet perhaps we could learn a thing or two from some of the best performers. . .

Take pain management as an example. Doctors in other countries try as hard as we do to treat the cause of the pain but, when they have done all they can and the pain persists, they call in the pain management specialists. In other words, they see the pain as a disease in its own right and have doctors who specialize in its treatment. Come back to this country and you do find the terms, Pain Management Clinic, or sometimes just Pain Clinic. In some states like Florida, there are more such clinics than there are branches of McDonald's. Except most of them are pill mills, i.e. all they do is sell painkillers. Oxycodone is the most popular pill. These are the dark side of prescription drug supply and, in some states, there are an increasing number of people dying because of painkiller overdose.

Why have our doctors not followed the example of best practice in other countries? The answer is money. Doctors in US hospitals get a reputation and earn high status by being profit-oriented. The more money they make out of their patients, the more the hospital likes and rewards them. In other countries, you will find teams of specialists working on a one-to-one basis with a patient. Thus, diagnostic specialists look back at the treatment to date and order new tests, physical therapists set up exercise routines to improve muscle tone, cognitive behavioral therapists help people cope with the pain, and so on. In our hospitals, one doctor is in a race to see the maximum possible number of billable patients in a day. No one has the time to sit down as a team and consider how best to approach the treatment of one patient. It's hardly surprising all our doctors do is issue more pills.

This is not to say Ultram or other painkillers are poor value. They do what they say and relieve pain. But they are not a substitute for a strategy thought out from the patient's point of view. Looking at treatments as a patient gives you a completely different approach where you use Ultram only when pain is flaring up and generally rely on alternatives to improve the quality of life.