By Jana Soeldner Danger
Is your doctor ordering too many tests and administering more treatments than necessary? At best, over-testing and treating can waste a patient’s time and money. At worst, it can cause actual harm. Older individuals raised in an era when questioning a physician was discouraged may be especially vulnerable.
“Some patients think the more tests they have done, the better,” says Dr. Joseph De Gaetano, associate professor of family medicine and associate dean of clinical curriculum and graduate medical education at Nova Southeastern University. “And some physicians are ready to order every test under the sun because they fear litigation.”
The monetary reward can be a major factor.
“The financial incentives are very compelling,” says Dr. Olveen Carrasquillo, chief of the division of general internal medicine and head of health services research and policy at the University of Miami Miller School of Medicine. “In the current ‘fee for service’ system, more tests lead to more financial gain. That’s one of the reasons we’re moving to an accountable-care system, where good medical care is rewarded, instead of the amount of tests performed.”
Metric scoring systems for emergency-room staff, originally implemented to reduce wait times, may result in unnecessary testing.
“It started as intent to treat quickly,” says Dr. Mark Lazar, a family-practice physician in Hollywood. “But what’s happened is that the nurse at the triage station orders tests to get them done before the doctor sees and evaluates the patient.”
Emergency rooms, Lazar adds, “should be scored on how good they are, not how fast they are.”
Unnecessary testing costs the patient money, and it can also result in physical harm. Guidelines for mammograms have changed, for example, yet many doctors continue to prescribe them annually for young women. Mammograms and other kinds of scans, however, introduce radiation into the body.
“The cumulative amount over a lifetime can be significant, and could itself be a cause for cancer,” De Gaetano says. “And no test is perfect. There can be false positives that result in surgical interventions, and every day patients have bad outcomes from surgery and anesthesia. There’s also the anxiety and stress people suffer in anticipation of a test.”
What are the solutions?
“Ask lots of questions,” De Gaetano says. “There are very few absolutes in medicine. Always be suspicious of a physician who is ready to order every test under the sun.”
“Patients need to realize medicine is a business like anything else,” Carrasquillo says. “You don’t buy a car just because the salesman tells you it’s the best one. Ask whether a test is really necessary, and what the risks are if you don’t have it. If you’re uncomfortable asking your doctor questions, you may want to rethink whether you want to be with that doctor.”
“If we take away ‘the more I do the more I make’ incentive, and take away the medical malpractice risk, everything will change overnight,” Lazar says. “You need to incentivize in the right direction by giving a doctor more money for keeping a patient healthy and out of the hospital – a reward for doing a good job and for cost containment.”