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Defensive Medicine Gets In Your Way

Posted Sep 15th, 2009 by Trisha Torrey

Have you ever gotten sick or hurt, visited your doctor, particularly a specialist, or even landed in the emergency room, then undergone a series of medical tests, and more medical tests, without really understanding what they were all for?

CT scans, MRIs, EKGs, PET scans… blood work and biopsies… these are names we hear for tests we may be unfamiliar with, but are ordered by the doctors we see. And they are all so expensive! Even with insurance, we can look at our statements and see what they cost. If our symptoms or diagnoses are at all frightening, we just don’t seem to ask many questions about medical tests. Like lemmings, we just take them or get them and wait for the results.

Would it surprise you to learn that maybe you didn’t need all those tests?

That the doctor requested them not for you, but for him?

There are a number of reasons we are subjected to so many tests that benefit the doctor, but not necessarily the patient. First, tests can substitute for time spent with patients. It takes doctors less time to review test results than it takes to ask us questions, listen to our answers, then determine exactly which tests are really necessary.  A doctor may think, why bother figuring out which test is just right, when he can order a whole battery, knowing one of them is bound to be the right one?

Another reason is income.  When doctors own the machines and instruments used for testing, like CT scanners or MRI machines, they get paid for running the tests.  Insurance reimburses doctors more for procedures than it does for patient face time. More tests mean more money in the doctor’s pocket.

Then there is “defensive medicine.” A survey in 2005 revealed that 93 percent of doctors have ordered tests, not to diagnose a patient, but to cover their own backsides. If that doctor treated his patient, then the patient ran into a problem later, he would need to prove he had done his job well. Producing results from that barrage of tests might get him off the hook.

Knowing all the benefits to doctors of ordering so many tests, I believe that if I were a doctor, I would order extra tests, too. Malpractice suits, regardless of whether they are warranted, cost billions of dollars each year. Even the very best doctors who never make mistakes pay tens of thousands each year in premiums for malpractice insurance. In some specialties, those premiums are even higher. One way they can keep their malpractice insurance costs lower is to order all those tests.

For doctors, ordering all those tests is win-win-win!

But what about us patients?  Well, guess who is paying for those tests? We are! In a number of ways.

First, money.  For each dollar spent on unnecessary testing or any other unnecessary service your doctor my order, you pay a portion of it, either in next year’s premium, or in next year’s taxes for Medicare or other government insurance programs. One estimate tells us that these unneeded tests are costing payers almost $130 billion per year. In fact, that is money coming out of our pockets to begin with.

Second, medical tests can be dangerous. They may expose us to radiation or infection. They take up our time or cause us to miss work.  They leave us with side effects that must wear off (think eye drops or dizziness from injected material or blood draws.)

So, while I understand a doctor’s motivation, I don’t like it. How can we patients make sure we aren’t being over-tested?

If your doctor orders a series of tests, ask the purpose for each.  His answer may reveal whether you really need them.

Tell him you want to be sure your insurance covers them, or that you can’t afford the tests because you are uninsured. Then, ask him what the alternative will be if a test isn’t covered or you can’t afford it.  Listen closely to his answer.  It may give you a clue as to whether it’s imperative you get that test.

By all means, if the test is necessary for diagnosing you or determining the next steps toward keeping you healthy, then be tested.  It’s important.

If not?  Then work with your doctor to find an alternative. 

Even if we understand why defensive medicine exists, we must practice defensive patienting, too.

 

About the author

Trisha Torrey is Every Patient's Advocate. She is a newspaper columnist, radio talk show host, national speaker, and the guide to patient empowerment at About.com.

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