Experts say doctors overuse diagnostic tests

The new federal health care law might not address whether doctors can run diagnostic tests even when it isn’t necessary, but it’s a tendency experts agreed is a problem.
 
The American College of Physicians, a national organization of physicians who specialize in the treatment of adult illnesses, claims that doctors are running too many diagnostic tests on patients who raise health care costs and that the doctors put patients’ health at risk.

The overuse of diagnostic testing can cost the U.S. health care system up to $250 billion, which is equivalent to about 10 percent of the amount spent on the nation’s health care, according to an article published in U.S.A. Today.

“The way to solve the problem is to change the way we pay doctors and put them on salary rather than fee-for-service, but getting patients more involved in the decision-making process can help too,” said David Orentlicher, a professor at the Robert H. McKinney School of Law in Indianapolis.

The problem that Orentlicher points out casts an even worse light on doctors’ motivations, a much talked-about issue due to the rising costs of medical care and the passage of the Affordable Care Act. Patient-doctor communication is also defined by doctors’ financial incentives, Orentlicher said.

“Doctors are like everybody else,” he said. “If you’re in a fee-for-service system where you’re paid more to do more, you’re going to do more. And I don’t think it’s conscious, but people are very responsive to financial incentives.” 

To bridge the gap between doctors’ decisions to run expensive tests and patients’ deference to doctors, medical schools have created ethics programs to train students on how to develop strong relationships with patients.

When Orentlicher attended medical school, ethics education was optional. But at the IU School of Medicine in South Bend, a new program has been designed to help medical students develop effective communication with future patients.

“Overuse of diagnostic testing reflects doctors’ fears of being sued due to lack of protection from tort lawyers,” said Forrest Craig, a second-year student at the IU School of Medicine in Bloomington.

The threat of litigation also hangs over current practitioners.

Eric Knabel, a doctor in family practice at IU Health’s Southern Indiana Physicians in Bloomington, said “defensive medicine,” a concept that motivates doctors to run tests to rule out all conditions, might be one of the reasons doctors run too many
diagnostic tests.

Knabel also said another factor is that some patients “want to have everything done” because they believe their insurance will pay for it.

“This puts the provider in somewhat of a predicament,” Knabel said.

On the other side of the spectrum, a lack of health insurance covering various diagnostic tests leads to a bad health care experience for patients.
 
Bloomington resident Lisa Milanovits, 49, used to be on her former husband’s insurance, the military health plan TRICARE.

“If you’re not the active member, you’re cattle,” she said.

About 11 years ago, Milanovits started experiencing back pain that stopped her from sitting or standing for longer than 30 minutes without feeling unbearable pain. Her chronic disease, called cervical degenerative disc disease, led her to receive several types of medical care, such as Workman’s Compensation and care from local clinics.
 
“I think that a big factor in that is whether or not you have the insurance,” she said. “If you have money, they will encourage you to get this, that and the other.”