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Helene Pavlov, M.D. Headshot

Fewer Tests, Lower Health Care Costs?

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The New York Times recently published an article -- "Doctor Panels Recommend Fewer Tests for Patients" -- that reported on the recommendations of a group of nine medical specialty boards and stated that 45 common tests and procedures are performed more often than necessary. The article noted that:

"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."

These same medical specialty boards are urging patients to question the need for these tests, if and when they are offered. A number of other specialty boards are preparing additional lists of procedures that they say experts should consider performing less often.

It is about time that the medical profession leadership focused on policing itself and reducing unnecessary testing. The health care system in America has created a culture of expectations that include immediate access to medical care and immediate answers to health care questions. Doctors often claim that they honor patient requests for medical tests to avoid malpractice and also so they do not lose the patient to another physician. Patients demand to know what is wrong with them and they expect everything that can be done to get the answers, ASAP. If one doctor won't order a CT, MRI or X-ray examination, then they will find another doctor who will. Litigation also plays a role in ordering examinations as tort reform is variable and doctors practice defensive medicine.

This is a vicious cycle. It is essential that patients question their doctors. Patients should ask their doctors what the test might reveal and how will the test results affect further management. If the diagnostic test is to recommend surgery or a treatment regimen the patient is not interested in pursuing, then the diagnostic test is not necessary. If the patient is interested in the potential surgery or management, then the patient should ask additional questions. Questions such as: Does the ordering physician financially benefit by performing the test? Who is conducting the test? Is that person subspecialty trained to administer and analyze the results of the test? Will the ordering physician "profit" if the test is interpreted as being abnormal or equivocal, because then an interventional exam or surgery may be needed to confirm or exclude the "finding." Also to be considered: whether or not the test is dangerous or harmful. What are the potential complications? Will insurance cover the cost?

Previously, I have written postings about self-referred imaging examinations, in which I identified that doctors tend to order more diagnostic tests when they self-refer (i.e., perform the test themselves) compared to when the test is ordered by a non-self-referring physician. Radiologists perform and interpret imaging examinations, including MRIs, but they do not order the imaging examinations. Owning X-ray, CT or MRI equipment is expensive. A non-radiologist physician who owns medical equipment needs to pay for the equipment and the upkeep. What better way to pay for equipment than by utilization? Unnecessary exams? Often times, yes. Unethical process? Absolutely.

Educating patients to inquire about their health care is key. As radiologists, my team and I regularly call our referring physicians to ask why certain examinations have been ordered, and when medical records are available they are checked to ensure that the patient has not received the same or a similar examination in the recent past. While most of the ordered examinations are usually appropriately ordered, if there has been a recent similar examination, we may
recommend to the ordering physician that the examination is not necessary "at this time."

Patients should participate in the process of questioning as to what medical exams are to be performed and why. Active patient involvement will have the strongest impact on helping to curtail unnecessary testing, which is contributing to the health care crisis.

Eliminating self-referral is essential. Eliminating self-referral would help reduce unnecessary testing and significantly lower health care spending. Most importantly, involvement of more unbiased health care providers, such as radiologists, in the patients' overall care might help improve and educate patients with their health care decisions.

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