Rationing or rationality? A panel of doctors from nine different specialty boards has just recommended that doctors stop giving their patients so many tests -- and it advises us patients to stop demanding them, too.
As a gal who goes to her doctors once a year (and flosses and sees the dentist, too), I believe in medicine and the folks who practice it. But I also believe, along with the American Board of Internal Medicine panel, that I've been given a lot of tests I haven't really needed. For instance, about a year ago, I had blood drawn after a perfectly perfunctory visit to the OB-GYN. Why? The doctor mumbled something about just making sure everything's shipshape. So vials were filled; insurance was billed; and the doc informed me that, yep, I'm shipshape. But our health care system?
That's another story. As pretty much everyone knows, we spend an awful lot on health care in America. The current price tag is $2 trillion -- a number so hard to comprehend that I'll write it out like this: 2,000,000,000,000 buckeroos. (Or, to put it another, even more graspable way: about $24,000 per family of four.) Now, of this, experts estimate that perhaps a third is spent on tests and treatments that are absolutely unnecessary. What a colossal waste!
So the panel, made up of cardiologists, radiologists, oncologists -- you name it -- went ahead and came up with a whopping 45 tests it would like to see curtailed. These recommendations include no more imaging tests (CT scans, MRIs, X-rays) for plain old back pain or for a one-time fainting spell. Nor does the panel want to see us undergo those tests before most outpatient surgeries. And the idea of doing big cardio workups on middle-aged folks just because they come in for a checkup? That, too, is under the gun, in part because a survey by Consumer Reports found that 44 percent of people ages 40 to 60 with no risk factors for, history of or symptoms of heart disease had nonetheless undergone screening tests for it. And those tests were "unlikely" or "very unlikely" to have any benefits that outweighed the risks!
Well, someone must be benefiting, or where did all this excess testing come from? It came from some legitimate places. First of all, doctors fear that if they miss some illness, we could turn around and sue them. So they feel they have to rule out even unlikely problems just to practice "defensive medicine." At the same time, patients often demand these tests themselves: Leave no (kidney) stone unturned, doc! Check out every single cell!
And then there's the ridiculous fact that doctors are reimbursed per test, so they have no incentive to cut back, because that's shooting themselves in the wallet.
If you ever have had a sneaking suspicion about whether you really needed that PSA test or ultrasound, these new guidelines will make intuitive sense. If you ever have seen a loved one suffer through an extra poke or probe, you'll cheer them, too. Goodness knows that when my mom, addled with dementia, was hospitalized for a leg infection, she sure didn't need the "swallow test" the doctors wanted to give her. Wasn't it pretty clear that she wasn't eating because she was out of her mind with misery? Couldn't anyone ask the caregiver or me whether my mom could NORMALLY swallow? It seemed like such a craven money grab: Shove something down the old lady's throat, and bill Medicare.
But of course, there are those who will see the panel's anti-excess-testing recommendations as rationing. To which I say: Great! It makes sense to ration unnecessary tests. In fact, it makes sense to stop them.