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ADVANCE Discourse: Lab

Overutilization: Who's at Fault?

Published September 29, 2011 3:34 PM by Kelly Graham
Overutilization of laboratory testing services is often discussed in the industry as relating primarily to physicians' levels of understanding about when and why to order which tests. But an intriguing blog post on the New York Times "Well" blog discusses some other reasons for overutilization.
According to a recent study in the Archives of Internal Medicine, doctors know they are delivering too much healthcare. They claim, however, that it's not because they don't understand the clinical utility of laboratory tests (or X-rays, pharmaceuticals, etc.). Instead, physicians are driven to provide excessive care to protect themselves from malpractice suits, because they don't have enough time with their patients, and more than half of the doctors surveyed felt that the clinical guidelines and quality measures in place are forcing them to take unnecessary measure in providing healthcare.
Of course, this isn't just looking at utilization of laboratory tests, but it's an important factor to consider for the laboratorian who may be baffled at some test requests from physicians. What do you think? Is the pressure coming at doctors from so many sides ruining healthcare? What instances of poor utilization does your laboratory see--and what can be done to correct the situation?
posted by Kelly Graham

2 comments

I agree that there are few physicians that practice like there is no end to the lab work. The more the merrier. Tpeople should be put on probation until they can learn to use their clinical impressions & support their findings with the lab & x-ray.

The best suggestion would be to put the entire legal system on a "DRG" basis for all of there law suits. If the lawyers knew that they were only going to recieve a set amount of a few hundred dollars versus 40% of any multi-million, they would reconsider filing so many of these frivilous malpractice suits. There is still a place for the the legitimate malpractice suit, but there are far to many filed that are not actually malpractice. Do to the legal system what they have done to the medical profession & you will see a huge drop in medical costs due to the fact the physicians can actually practice medicine instead of practicing a CYA method!

Glenn , General Laboratory - Tech Supervisor October 1, 2011 8:42 PM
Aurora MO

This is very interesting that this topic of conversation is being brought up.  It has been in my experience at several hospitals that I've worked for where I see Doctors, particularly emergency medicine, order questionable tests.  For example: why a type screen on a patient with a 15 Hgb? Also, there are physicians on the floor who insist on ordering routine labs overnight and insist that they be drawn immediately instead of performing them with the AM labs.  Also, I've seen a doctor order blood cultures x's 2 every eight hours AFTER the first set came back positive.  I did have one lab Director that was very observant and proactive towards over-utilization. She would actually tell physicians, "we run the lab, not YOU."  Over-utilization does nothing for the patient except overburden them with unnecessary out-of-pocket costs.  Not to mention the fact that this costs the laboratory valuable time and resources.  Labs across the country are spread way too thin.  In a time when we need to lower our healthcare costs physicians, in an attempt to CYA or "pad the bill"are major part of the problem.  I recently spent 9 hours in the Emergency Room with a loved one who was sent there by her doctor for having dangerously high blood pressure.  A CT was done immediately, but no medicine was given for her hight blood pressure until 6 hours later.  During that time, the radiologist commented on the CT report that there was "stool in the colon."  The ED Physician ordered stool softeners, laxatives, and an enema...plus, every kind of stool test imaginable, from CDIFF toxin, Stool culture, stool WBC, Occult Blood, etc....  When I questioned the ED Physician about this obsession with my loved one's stool, and lack of attention to her blood pressure (systolic peak of 240)? I received an arrogant remark of, "Where did YOU go to medical school?"  I hate to say this

, but over-utilization IS not just about CYA, it is blatant FRAUD because the average consumer does not have the information available to question these practices and family members are ridiculed for asking.   Physicians are their own worst enemy, not the law suites.  

Marci , Hospital Laboratory - Clinical Laboratory Technologist October 1, 2011 2:15 AM
Billerica MA

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