Too Many Tests?
Yesterday the New York Times ran an essay called "Many Doctors, Many Tests, No Rhyme or Reason" by Sandeep Jauhar M.D. that outlined a specific case, where the author felt that the expert consultations and tests spiraled out of control. Because the article did not give the final diagnosis or any reason that all the specialists were consulted or tests performed. It was a little hard to know if indeed some of the care was excessive.
Later in the article, the author speculated that the growth in medical imaging has been influenced not only by the ability to get better diagnostic information and the fears of litigation but to a large extent by financial incentives.
To make his case, he gave an example of a cardiologist he visited who offered nuclear medicine gamma imaging in his office. The quotes from the physician seemed to show that he ordered un-necessary nuclear medicine tests when needed to make sure that he was able to break even on the costs of the machine rental, the technologist salary and other expenses. The article quoted him: "Now say I get an average $850 per nuclear stress test...Then I have to do at least 10 stress tests a month just to cover the costs, no profit going into my pocket."
My first response to the article is "why did he have to pick on nuclear medicine as the example, considering that all the other diagnostic tests have also increased greatly, with some people questioning whether they are needed."
Then I began to wonder if there might be some truth to the claim, especially as outpatient cardiology clinics have added nuclear medicine studies to their in-office cardiac offerings.
I know that there were a couple of times that I performed lung scans on ICU patients who were so sick, and on so many machines, that I wondered whether it would have been kinder to just let them alone, since they were so obviously close to death. As a technologist, however, I was not privy to whether the information from the scan really did aid in prolonging their life or reducing their pain. Indeed, during the time I worked in nuclear medicine, I never felt that any imaging tests were ordered for reasons other than to gain additional diagnostic information that might improve that patient's potential care. Have you seen any indication in outpatient facilities or in the hospital that there is a move toward ordering nuclear medicine scans for questionable reasons, such as litigation worries or financial gain?