A Tale of Too Many Tests

As a healthcare consumer, I feel an urgency to do my part to decrease unnecessary cost and improve quality. As a member of HORNE's Healthcare team, I have a greater understanding of why our healthcare system cannot continue in its current state and I've learned that reducing variation and eliminating waste is our “how”; however, since I am not a healthcare provider, my impact is limited in what I can do as a patient as I view my own healthcare, and the care of my loved ones, through a new lens. 

I recently encountered two cases of unnecessary (and costly) tests involving people close to me. In the first case, an 82-year-old man presented to the ER with a distended stomach, vomiting, and the inability to have a bowel movement for days. X-rays suggested an obstruction which was confirmed by a CT scan. A colonoscopy was performed and biopsies were positive for cancer. Surgery was subsequently performed.  But I wondered, once the diagnosis of an abdominal obstruction was made, wasn’t surgery imminent?  Why continue with additional tests? Was it necessary to undergo a colonoscopy when surgery was required regardless? We weren’t presented with other options. 

In my second experience, a 50-year-old woman had a screening mammogram with questionable results.  After a second mammogram, an ultrasound was ordered which then led to an MRI. The MRI results were normal, but because of the suspicious results of the prior tests, a biopsy was performed. If the MRI had shown a mass of some kind, the next step would have been a biopsy. But even when the MRI didn't indicate a mass, the next step was a biopsy. If a biopsy was always going to be the next step regardless of the outcome, then why was a MRI necessary? No one addressed these questions. 

Doctors have traditionally been paid on a fee-for-service basis, and have been encouraged to be productive. I don't believe doctors are just "in it for the money". And I don't believe doctors intentionally order excessive tests. I believe we (patients) have become accustomed to a world where insurance provided the ability to have tests performed without a huge cost to us personally.  

This is our norm. We’re comfortable the way things are. Patients want tests. 

"What's wrong with me, Doc? Can't you do a test to see?" Tests make us feel safe and secure in our knowledge of our health and well-being. Doctors want patients to be happy and healthy. In both of the cases above, eliminating tests would not have changed the outcome but would have reduced the cost. Clinicians and patients have to be willing to forego additional tests when it makes sense to do so. 

In the near future, providers will find more and more patients who demand transparency – of both information and price. Opportunities to decrease costs without decreasing the quality of care surround us, and providers will find educated patients to be their allies in capitalizing on those opportunities.

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Topics: Quality Improvement, Patient Care

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