Sunday, November 6, 2011

Examples of how doctors push tests and procedures on patients

One of the most common ways that doctors increase the cost of patient care is by over ordering imaging studies. CT scans are one example. One of the simplest ways to document overuse is by examining the number of double CT scans ordered, that is sequential scans, one with iodine contrast and the other without. According to experts there is no need to perform both. The contrast scan provides all the information of a non-contrast scan. Not only does the double scan increase costs, but also increases radiation exposure. It is estimated that radiation from one CT scan = 350 chest X-rays and two would equal 700 CXRs. Concerns have been raised that CT scans may be predisposing patients to cancer. Just as observed with per capita health care expenditures, and costs in the last two years of life, the percentage of double CT scans varies in different regions of the country, being 1% in Massachusetts and 13% in Oklahoma (for more details see http://www.nytimes.com/2011/06/18/health/18radiation.html?pagewanted=all).

MRI is another overused, imaging procedure. The good news is this test is not harmful to the patient, but is harmful to the pocketbook.  The New York Times recently reported the observations of Dr. James Andrews, a widely known sports medicine orthopedist in Gulf Breeze, Fla. He performed an MRI on 31 health professional baseball pitchers (see http://www.nytimes.com/2011/10/29/health/mris-often-overused-often-mislead-doctors-warn.html?hpw) and found abnormalities of the shoulder rotator cuff in 87% despite the fact that they had no complaints of shoulder pain and felt perfectly healthy. Such abnormalities too often are used to justify unnecessary shoulder surgery in the unsuspecting athlete.

Why do physicians overuse tests in some parts of the country and some hospitals and not in others? And how can physicians and patients improve our push model of health care?  I will share my thoughts in my next piece.

1 comment:

  1. I think that you will find that the pattern of test overuse (and medical resource overuse in general) follows the perceived risk of liability. The most use of tests will be in those markets that are the most litigious.

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