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Medicine as Ecoculture
Annals of Internal Medicine, 10/20/09

Gillick MR – Expenditures on diagnostic tests are increasing dramatically, with marked geographic variation; spending on imaging alone has increased by 17% per year.

Regional variability is not associated with improved outcomes but has been associated with discretionary spending on a greater supply of hospital beds, specialists, and equipment.
An explanatory model of the health care system, drawn on an analogy with the ecosystem, can help us understand why new technology is introduced in particular regions and how physicians come to use the new technology.
Physician sociology and psychology, along with economic forces, are critical to understanding physician behavior.
Effective health care reform needs to take into account the medical ecoculture by stimulating change at multiple levels, including the organization of physician practice, regulation, and device manufacturers, as well as reimbursement.

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