According to a recent study by the Mount Sinai and Brown University schools of medicine, primary care physicians prescribed at least $6.8 billion worth of unnecessary tests, procedures and medications to patients in 2009.
The study considered tests and procedures unnecessary if the patient exhibited no apparent symptoms or risk factors linked with the disorder associated with the test.
Some of these unnecessary tests included ordering a complete blood cell count during a routine physical, which accounted for more than $32 million in 2009. Physicians were also found to order bone density scans in women younger than 65 showing no signs of osteoporosis and ordering pap smears to test for cervical cancer in women under 21.
The $6.8 billion figure is conservative, according to the study’s head author Dr. Minal Kale, because it does not include the emotional and financial costs of incorrect test results. Many imaging scans return false positive readings because the human body can develop numerous benign growths, which are indistinguishable from cancer on many scans.
These false positives can result in even more unnecessary tests, which increase both a patient’s hospital bill and anxiety.
False negatives are also a major problem with a variety of tests. If a scan fails to detect any abnormalities, many patients will disregard future warning signs and symptoms believing they are perfectly healthy after receiving a battery of tests.
While medical scans have progressed dramatically in the last few years, they are still relatively unreliable for diagnosing conditions without other symptoms and risk factors.
Patients, doctors and insurers are all to blame in regards to unnecessary testing since many doctors have a financial stake in ordering more tests while patients have forced doctors to constantly cover their bases to avoid malpractice suits.
The current medical insurance model facilitates over-testing by encouraging patients to adopt an all-you-can-eat approach to their medical care since they only pay their hospital bill indirectly. Doctors are also encouraged to subject insured patients to a variety of expensive tests to increase hospital revenue.
A poll by the Jackson Healthcare consulting firm found 73 percent of doctors admit to practicing defensive medicine, ordering tests and procedures they believe are unnecessary for patient care, but necessary for avoiding potential lawsuits. The polled doctors estimated defensive medicine is responsible for roughly one quarter of the $2.5 trillion spent on healthcare in the U.S. annually.
CT scans are a major area of concern since they subject patients to several hundred times the amount of radiation of a standard X-ray while only being more diagnostically relevant in a few cases.
One study from the New England Journal of Medicine estimated the radiation from the more than 62 million annual CT scans could be responsible for as many as 1 in 50 future cancer cases in the U.S.
Many patients happily accept CT scans and other likely unnecessary tests because they only feel the costs indirectly in their rising health insurance premiums. Patients would also rather run tests than talk about making serious lifestyle changes which would be much more likely to improve their health but requires more personal sacrifice than running “free” tests.
Our current medical system incentivizes doctors and patients to take advantage of unnecessary tests, which can do more harm than good. Unfortunately, changing this system will require removing financial conflicts of interest from doctors as well as educating patients, while somehow reducing doctors’ risks of malpractice suits.
Dr. Stephen Smith of Brown University believes medical schools are partially to blame for the rise of unnecessary tests, saying American doctors are “raised in an educational environment where we got dinged if we didn’t order certain