Doctor Panels Recommend Fewer Tests for Patients

[cbayer]

Source: New York Times

By RONI CARYN RABIN
Published: April 4, 2012

In a move likely to alter treatment standards in hospitals and doctors’ offices nationwide, a group of nine medical specialty boards plans to recommend on Wednesday that doctors perform 45 common tests and procedures less often, and to urge patients to question these services if they are offered. Eight other specialty boards are preparing to follow suit with additional lists of procedures their members should perform far less often.

The recommendations represent an unusually frank acknowledgment by physicians that many profitable tests and procedures are performed unnecessarily and may harm patients. By some estimates, unnecessary treatment constitutes one-third of medical spending in the United States.

“Overuse is one of the most serious crises in American medicine,” said Dr. Lawrence Smith, physician-in-chief at North Shore-LIJ Health System and dean of the Hofstra North Shore-LIJ School of Medicine, who was not involved in the initiative. “Many people have thought that the organizations most resistant to this idea would be the specialty organizations, so this is a very powerful message.”

Many previous attempts to rein in unnecessary care have faltered, but guidance coming from respected physician groups is likely to exert more influence than directives from other quarters. But their change of heart also reflects recent changes in the health care marketplace.

Read more: http://www.nytimes.com/2012/04/04/health/doctor-panels-urge-fewer-routine-tests.html

[Snake Alchemist]

1. How can any doctor in good conscience order an unnecessary test to make a few extra bucks? nt

[emilyg]

2. I'm a retired nurse and

I can tell you many do. Worked for a doc years ago - a young girl came in with her mother for a pregnancy test - the doc immediately ordered a hair analysis. WTF

[unblock]

4. hair analysis can identify toxins (both legal and illegal) that could be passed to the fetus

depending on how the office visit played out, it might not have been a bad way for the doctor to find out if there were any potential complications without embarassing the daughter in front of her mother, or without worrying that the daughter would lie regardless. or the doctor may have had reason to suspect drug use (it can be obvious if you know what to look for).

[emilyg]

12. This doctor ordered hair analysis for everyone. She

had a sweet deal with the company.

[cbayer]

13. Hair analysis for what?

[unblock]

15. money, from the sound of it.

it may be indicated in some circumstances, pre-natal/pre-conception care being one of the possibilities; but certainly not ALL cases.

[emilyg]

16. for the $50 cash kickback.

[cbayer]

31. I still don't understand. What are they analyzing the hair for and how do you know

there is a $50 cash kickback?

There has got to be more to this, because it just doesn't make sense.

If there's a *kick back*, that would imply that someone somewhere is paying for the test and deems it legitimate.

Or is the physician involved in some kind of clinical trial?

[emilyg]

34. I worked with this doctor

for 12 years. I was at her house one day and she showed me an empty detergent box under her sink filled with money. Told me how she got it. Not all doctos are ethical. Not all labs are ethical.

[magical thyme]

21. random urine med tox screen for drugs

is probably cheaper than hair analysis. And since pregnancy tests are fast, and use urine, you could confirm pregnancy *first* and order med tox screen only if pregnancy test is positive.

[unblock]

29. i can't speak to the cost (though i would guess you're right)

but a tox screen may be a good idea even if you're not yet pregnant but are planning to become pregnant (or at least, uh, engaging in behavior that could lead to pregnancy). ideally, you're completely detoxed prior to becoming pregnant.

[cbayer]

3. It's more complicated than that, imo.

Many, many tests and procedures are ordered because:

that's been the standard for a long, long time

and

physicians are covering their butts because they are more likely to be sued if they deviate.

[Lost-in-FL]

6. In the ED, drs order a lot To compensate for their lack of clinical knowledge...

Lots of ER's hire newly graduated family practice doctors and not experienced Emergency Medicine doctors which are very good diagnosticians.

Also, patients requiring specialists due to their condition being out of the ED physicians scope of practice are further subjected to frivolous testing because the on-call specialist doesn't feel like coming in (even when they are paid for being on call). Example, a person had to have CT Abd/Pel for appendicitis, even when all blood tests and physical examination points to this anomaly because there is not enough staff on the OR to do emergency surgery (staff shortages to save money, not for lack of employees).

[cbayer]

7. Agree on most counts.

ED's are a different animal, though. These groups address mainly routine tests, tests for non-emergency conditions and repeated tests for the same complaint.

Another big issue is patient expectations. Patients have been trained to expect testing, and lots of it. They also want answers, even when there aren't any.

[SWTORFanatic]

14. I had a doctor give me a tetanus shot when I came in after a

working on the car accident (working on the car... not a car crash). I dropped a brand new aluminum flywheel on my chin and cut it open pretty bad. Why would I need a tetanus shot for something made of aluminum that was brand new out of the box?

That was before I had insurance too. I think now though I've finally wised up to the point where I'm going to refuse every single test unless the doctor basically tells me it's 100% necessary or at least absolutely foolish to skip.

To add insult to injury, the ~$200 for the shot didn't hurt as much as the shot did and I'm far from a wuss when it comes to that. I couldn't do some of my workouts (particularly shoulder presses) for over a week! I think the nurse butchered it and irritated the injection site somehow.

[zipplewrath]

20. Because you were working on your car

I presume you weren't "current" on your tetanus shot. A doctor would have ordered one at a physical.

In this case you were in a "dirty" environment and the infection could have come from what was on your face when the fly wheel hit it.

Basically he saw a chance to "update" your tetanus shot and he took it.

[SWTORFanatic]

30. On a brand rebuilt, hot tank cleaned engine and brand new in box

aluminum flywheel?

I didn't do anything other than work on putting the flywheel on (or better yet dropping it on my face). It was as clean an environment as any other than a surgery operating room.

[zipplewrath]

35. Which is about the only place

An operating room is about the only place clean enough not to warrant a tetanus shot.

Like I say, I am presuming you weren't "current" on your shots. I had a shot during a physical, and I had no "recent" injuries at all. You had an open wound from working on your car. Yeah, you were getting a shot. And aluminum, steel, ceramic, it doesn't matter what it's made OF, it matters what's ON it. The box it was in was far from "clean".

And yeah, tetanus shots hurt enough when their done right. If she did it poorly, it's gonna hurt for a while.

[cbayer]

39. If you were charged $200 for this shot you were completely ripped off.

Even if it was the new one that also contains a pertussis vaccine, you were charged almost three times what you should have been.

I would challenge that.

And, yes, tetanus shots hurt, but they can save your life.

[IamK]

18. To protect them from a lawsuit for missing early signs of ????????? n/t

[abelenkpe]

5. Initially read that to say: Doctor Panels Recommend Fewer Treats

So glad that's not the case!

[siligut]

8. To coincide with the lab tests Medicare scam?

The scam works like this: Quest and LabCorp provide kickbacks to private insurance companies - in the form of deeply-discounted and sometimes below-cost lab fees. In exchange, the insurance companies pressure doctors in their networks to send all of their patients' lab work, including Medicare and Medicaid patients, to either Quest or LabCorp. The labs fund the kickbacks (lower lab fees for private insurance patients) by overcharging Medicare and Medicaid patients anywhere from 70% to 500% higher. For example, Quest charged the State of California $8.59 for a complete blood test, but billed private insurers only $1.43.

http://www.marketwatch.com/story/medicare-scam-by-quest-labcorp-exposed-says-npt-associates-2012-03-23

[cbayer]

11. I think this is a different issue, but it will certainly impact these corporate lab companies.

[bloomington-lib]

9. Hopefully the solution to the healthcare problem doesn't become offering less of it

[cbayer]

10. Doctors have been in a corner for a long time on this issue.

As a group they know that much of what they do is wasteful and unnecessary, but they have felt they had no options.

Having guidelines which hopefully will precipitate a shift to being more thoughtful and evidence based when choosing diagnostic tests and procedures will be a great relief for many.

Unnecessary tests and procedures are bad for patients.

[Jigs]

17. I agree

However the threat of lawsuits if they don't check for fingernail fungus or an ingrown pubic hair will always be there ( I'm being extreme obviously )...

The expense of "ambulance chasers" is one of the rare things that it seems both conservatives and liberals have at least a small common ground on ( not that we won't rip each other apart over it anyway :p )

[Daemonaquila]

19. I'm disappointed that so many here are drinking the kool-aid.

I am a disability attorney, and before that I worked in the medical field many years. Why are so many of my clients disabled? Because doctors are NOT doing tests when they should, and people are not getting diagnosed and treated appropriately.

Absolutely, there are crooks and fools out there, ordering expensive tests. Chiropractors especially, teaming with companies doing hair, vitamin panels, and other tests that are suspect to begin with, are prime examples. However, "overtesting" happens virtually exclusively in ERs (CYA that the patient isn't having a stroke before they kick them out, to prevent lawsuits, etc.) and when patients have decent coverage. Most people do not, and a large number are literally dying for lack of testing, radiology, etc. This blanket set of recommendations will most strongly effect the poor and uninsured, who will have an even tougher time getting appropriate care.

[zipplewrath]

22. Careful

Read the larger report.

Much of this isn't so much about testing, although that is some of the suggestion. But there is also ALOT in there about unnecessary TREATMENT, and a good portion of it is coming from the oncologists. There are people within DAYS or weeks of dying that are going through chemo. NO ONE on the medical side thinks it is either necessary OR useful, but the patient (and family) want "something done".

I was dismayed as a I watched my father go through chemo and radiation treatments for a cancer that was questionable he even HAD and even if he did it would have been VERY unlikely to be the cause of his ultimate death. I'm fairly sure it accelerated the onset of his ultimate dementia problem.

[magical thyme]

23. not where I work

There are a couple doctors that are notorious for over-testing. I recently had one of them order, among other expensive wastes, a double set of blood cultures for *pink-eye.* Not in the ER, but at 2am up on the floor.

[Lost-in-FL]

27. I can believe that...

and if you happen to be a woman they order a full STD profile if you are single and of reproductive age even if you were having a migraine. Young males, if they are minorities, get drug tests... even for a flair uo of crohn's.

[Neoma]

24. I was gonna say...

I have to have tests all the time, depending on which pills I'm taking. Making sure I don't have a heart attack or get diabetes. Making sure that my liver still functions. Trying to keep my B-12 levels high, but not too high. That sort of thing.

This is pretty routine stuff to me.

[Lost-in-FL]

26. "Because doctors are NOT doing tests when they should...

...and people are not getting diagnosed and treated appropriately." Sure, cause like you said, they order tests depending of what kind of insurance they posses or who you are $$$.


What's this kool-aid thing you are talking about? I hope you are referring to the "lawsuit" part cause I know hospitals are running with this "lawsuit" excuse all the way to the bank. Medical companies also push for certain procedures to be done just to SELL their equipment when a basic study (in ER) could still make a diagnosis.

Just this week, I hear for the first time about a patient in the ED that is going throught radiation poisoning treatment... and no, the person is NOT a Nuclear scientist but someone who had too many X-rays in a short period of time!!!

[cbayer]

33. Are you honestly taking the position that most people on disability are on it because

of medical malpractice? Really?

Perhaps it's the kinds of clients you recruit or attract that has skewed your sample so badly.

While I share some of your concerns about chiropractors, but your statement that over testing is *virtually exclusively in ER's* is patently false.

If anyone is dying from lack of testing, it is because they are uninsured. This set of guidelines will most assuredly primarily effect the insured, who pay little or nothing when tests are ordered and often demand further testing.

You may want to look into this a little more carefully.

[goclark]

25. I have changed my thinking on Dr.'s

I have changed/fired several of my doctors because they were about my same age.
They are nice people but from my recent experience, they are too tired ~ that is why I ReTIRED. : )

My father was a Dr. and a good one but the world moves faster now.

I recently changed to two dr's that I adore. Both are in their mid 40's.

They are Not TIRED and they are up on all the latest procedures.

Both work out of a famous hospital here. They instantly can go on line and see results of all my tests, procedures. That is a major thing for me because I'm too old to remember what each doctor told me to tell my other doctors --- the patient should not be the messenger IMO.

[Odin2005]

38. I like older doctors, myself.

They all seem friendly in that old-timey family doc sort of way and have loads of experience.

[JNelson6563]

28. This happens frequently, in dentistry too.

There have been times back in the day when I could get medical or dental treatment that I nixed various tests/procedures. I was pretty plain spoken about it too. I would tell them I didn't believe it was necessary and since I was paying cash, I didn't want it. More often than not they would admit it really wasn't all that necessary.

I marvel at some of what I'm reading here. Man, I can't believe how much some of you all go to the doctor! And the post somewhere up-thread stating that surely someone must be current on their shots as that would be covered during check-ups. "Check-ups"??? lolz I wonder how many others this is a completely foreign concept to, something the well-to-do have time and insurance for.

Wow! I am starting to suspect some here really have no clue what the hell it's like out here for so many of us.

Julie

[zipplewrath]

37. You will soon

"Check ups" are covered "100%" by my insurance plan. Yours probably will soon too. I frequently only go about every 5 years or so. But some years, when I've got some issue, the doctor just treats it as a "check up" to get it covered. He can even run tests and have some of them covered too. That's when they check on various shots one is suppose to have.

[lovuian]

32. I know lab tests are definitely over done

it is ridiculous
you get poked every morning in the hospital
even if your labs are normal

[Odin2005]

36. Lab tests are definitely overdone.

It's because docs are afraid of malpractice suits and are covering their asses from potential litigious assholes.

[Lost-in-FL]

40. An excuse to order an infinity of test...

Last edited Thu Apr 5, 2012, 03:39 PM - Edit history (2)

and the doctor don't even have to see the patient. Patients come to me asking me who ordered their test... because they have not even seen an RN or doctor that day. After further research on who ordered the test, it was simply ordered by the unit secretary (under the guidance of an RN or PA) when the patient was still on the waiting room. That is why I continue to say that doctors and hospitals are running with this 'excuse' all the way to the bank and turning ER's into assembly lines.

[cbayer]

41. If a secretary is ordering tests, they need to be fired and the hospital reported.

I've worked in many an ED, and what you describe is just not accurate.

ED's are overwhelmed all over the country by the hordes of uninsured who can't get care elsewhere.

There aren't enough doctors, nurses or beds to cover the population that comes there. Many hospitals have gone so far as to close their ED's because they don't want to deal with it. What you are describing is just not accurate.

[Lost-in-FL]

42. Let's just say, that is not the way to do it.

But for the sake of 'getting things rolling', sometimes they take some liberties.

"Protocols" can be implemented to bypass certain procedures and later approved by an MD's so it is not ilegal.

[cbayer]

43. It is true that there may be protocols and some advanced practice nurses or pa's

can implement those protocols.

But is a secretary is really ordering tests, the hospital runs a significant risk of being shut down by the Joint Commission or CMS.

[Lost-in-FL]

44. I don't think this is widespread (I hope not!)

But then... I live in Mickey's State, where most everything is a joke.

I loooove my primary doctor. If I get so sick that I cannot wait for an appointment, I go straight to one of those Urgent Care facilities. They are well staffed and their doctors are very good and welcoming. They actually take the time to talk to you and are very through. It pretty much feels like going to your primary doctor.

[cbayer]

45. I am going to guess that you have insurance, because

those who don't don't have a primary doctor or access to Urgent Care facilities (unless they have some significant disposable income).

I am glad you have found a doctor that you like. One of the reasons that the doctors in Urgent Care facilities are so happy is because they are not ruled by EMTALA and don't have to see any uninsured patients. They are taking the butter right of the bread.

[Lost-in-FL]

46. Imagine that! I knew it had to do with $$$$$

Yes I do have insurance... I am reminded of it every time I visit my OBGYN and hear the line "Dr. X just ordered this for you... oh, wait... what insurance you said you have?".

At the beginning of the year I had X test done and concerned about not hearing about my results, I called the office. I had to wait on hold for an unusually long period and then, got the Office Manager (I was like... m'kay...why do I need to talk to the office manager?). She said that I was never there for that test (even when I specifically made an appointment for that particular test). I told her I was not crazy, and that I remember having THAT test done how could anybody "not remember" getting THAT particular test done??? Then she transferred me to the charge RN who said that since my visit only covered one free preventive care visit per year... I interrupted her to ask... so what happened with the test I remember getting done? She answered me that I never had that test done that day and that I need to make another appointment to get that test done!!!!! I just hang up the phone in shock... thinking that this was not possibly happening... that these people just trashed my specimen to make me go on a second appointment??

Imagine the thousands of people without insurance??!!! It is getting scary out there. Welcome to the Medical Industrial Complex era!!