Saturday, March 15, 2008
Too Many Tests, Too Many Doctors
I've written often about the primary care doctor shortage and the crazy system of health care financing that we have in the United States. To get a clear example of this, check out the great op ed article in the New York Times, titled "Many Doctors, Many Tests, No Rhyme or Reason."
The writer, a medical intern, had his eyes opened when he witnessed a 50 year old man who was admitted for shortness of breath, ended up staying a month in a hospital with consults by a hematologist (blood specialist), endocrinologist (gland specialist), podiatrist (foot specialist), two cardiologist, nephrologist (kidney specialist), ID (Infectious disease), pulmonary (lung), urologist (male urinary), Gastroenterologist, nutritionist, pain specialist, two surgeons and a thoracic surgeon.
The patient underwent 12 procedures, including a pacemaker and cardiac cath. His main diagnosis (which does cause shortness of breath) was anemia.
The question to be asked is, did that extensive and mind boggling expensive work up benefit that patient? It wasn't mentioned in the article but I am pretty certain he was not paying the fee. Either an insurer (read the working guy) or Medicaid (read your taxes) coughed up the dough for the hospital, the tests and the 17 doctors.
In the "old days", when patients had a family doctor or Internist, there was someone to coordinate and manage the patient. Now, if a patient sees an Orthopedic physician for a bad knee and surgery is planned, the Ortho doc will ask for surgery clearance which can start the cascade of one specialist after another. Some of this is defensive medicine, some are thoughtless referrals, some are feeding patients to your buddies.
For example a cardiologist may find an abnormal EKG. Without an old one to compare, he may think those extra beats are worrisome and that leads to more tests and more referrals. The physician thinks they are doing the best by being "complete and comprehensive" but you end up with the scenario of multiple consults and tests that have nothing to do with the knee replacement.
Less than 20% of medical school trainees choose primary care medicine and studies show that even fewer stay in the field to practice. That means we are cranking out more and more ultra specialists. Studies show more specialists do not translate to better care and in fact, there is an inverse relationship with quality outcomes and more specialists.
Read the Op Ed. It's an eye opener and sadly very true.
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