November 19, 2019

Tests, Tests, and More Tests: A Result of Defensive Medicine

If you are like most Americans, your health bills are soaring.  One reason is the number of tests ordered by physicians as part of an annual health review or physical.  The diagnostic or imaging industry, which includes X-rays, CT scans, and MRIs is booming.  Imaging is one of the fastest-growing services in medicine with costs reaching approximately $100 billion dollars annually.  CT scans are requested for many of the 45 million patients who suffer from headaches to rule out their greatest fear – a brain tumor.  Numerous studies suggest that this is overkill.  Most headaches are not indicators of something serious.  More serious conditions are usually accompanied by other visible symptoms such as seizures and neurological impairment.  In the absence of such red flags, a scan is not worth the risk of increased radiation exposure which can amount to more than 100 conventional X-rays.

A full body scan, a virtual physical, where every inch of your body is scrutinized from the inside has been marketed in recent years to perfectly healthy individuals.  However, these scans often find irregularities that are entirely harmless but nevertheless lead to many expensive, unneeded, and invasive procedures.

With less time available today, some doctors may order images as a shortcut, a way to get quick answers.  Excessive ligation forces doctors to practice defensive medicine.  Even if there is little chance of a serious disease or condition, a physician may order a test to reduce the risk of being sued later for missing something important.  Unfortunately, a growing number of physicians own diagnostic facilities or equipment and may order the tests because the fee goes to their bottom line.  The college of physicians is pushing today for what is referred to as “high-value, cost conscious care.”

For the first time in twenty years, a government panel is telling women in their 40s to stop getting routine mammograms and recommending that a host of other breast cancer screenings slow down because the benefits of testing do not outweigh the harm and risks.  Even those all important cholesterol tests seldom are needed every year.  Unless your cholesterol is very high, many guidelines suggest a test every five years.  Pap smears for a routine cervical cancer check are only needed once every three years by most women.  Yes, simple tests can harm.  A 52 year old woman wound up with a heart transplant after another doctor ordered an unneeded cardiac scan that triggered a false alarm and further testing that in turn punctured her aorta.

Researchers have also found more evidence that annual prostate cancer screening, called PSA test, in men doesn’t save lives.  For the population at large, PSA screening may not be beneficial.  The majority of prostate cancers are very slow glowing tumors and men will probably not die from it.  However, if a man is diagnosed with prostate cancer he is most likely going to choose the most aggressive treatment.

There is no doubt that we face an enormous task today in our attempt to monitor a host of life threatening diseases including carotid artery blockages and the threat of stroke, colon cancer, breast cancer, heart disease, kidney disease, and, of course, prostate cancer.  But defensive medicine adds $650 billion dollars to the cost of our annual healthcare in the United States.  Many claim that this cost is intended to avoid lawsuits rather than treat patients.  About 6% of a physician’s total compensation comes from medical orders such as prescriptions, imaging, lab tests, admissions and surgery fees.  Many physicians practice what is called “rule-out medicine” rather than diagnostic medicine out of fear that they will miss a diagnosis and be sued.  Many physicians will run tests on 5 or 10 year cycles that repeat the same tests given just a few years ago.

There is no doubt that developments in medical technology including methods for early detection of disease have had a marked reduction in prevention of serious illness and death.  But with the shift from the old techniques and their replacement with treatments using new medical devices and diagnostic products, it is also not surprising that these new procedures come with a hefty price tag.  The medical field has to be able to use these new methods cost effectively protecting their patients from unnecessary and needless testing and do all in their power to hold down the skyrocketing cost of healthcare.

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Written by
Donald Wittmer

DONALD WITTMER is a retired business executive who held key roles in the automotive and banking sectors. For a time, he also served as a Fiscal Agency Manager for the Detroit branch of the Federal Reserve Bank of Chicago. He received his undergraduate degree from Cincinnati's Xavier University, an M.A. in business management from Central Michigan University, and earned certification in bank operations from the School of Banking at the University of Wisconsin-Madison. A husband, father, and grandfather, he teaches part-time at the Kent Place School for Girls in Summit, New Jersey.

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Written by Donald Wittmer
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