Fear and greed are potent motivators. When both of these forces push in the same direction, virtually no human being can resist. And doctors -- despite many expectations to the contrary -- are human beings.
An interesting article by Dr. Andrew Weil where he discussed over-use of diagnostic tests. There is a quote from an ER doctor who talks about doctors taking patients with ridiculous complains and treating them as serious as a heart attack because they are afraid of a lawsuit.
"Incredibly expensive, unnecessary, and potentially harmful X-ray scans are ordered with gay abandon on all patients to make sure that 'nothing is missed' that a lawyer might later use against the ER. Patients with the most ridiculous complaints are admitted to the CCU [critical care unit] just to make sure that an MI [myocardial infarction, a.k.a. heart attack] is not missed. I would guess that $10,000 dollars per day or more of wasted X-ray radiation studies occur in our ER everyday. Multiply this times 365 and times the thousands of ERs in the country and you come up with billions and billions of dollars of pure waste in our system."
Well... as a patient who remained undiagnosed for many years, and was generally not taken very seriously by the medical teams checking me out, I am a little bit saddened by this viewpoint. I am sure that there are many people who abuse the emergency care system. One of the reasons for this is that if people don't have any health insurance they probably lack a primary care doctor and tend to make more ER visits that are probably unneeded. People without insurance are also more likely to try to ignore problems until they become serious, costing more money for the system in the long run than if someone just paid for them to go to the doctor and fix problems before they require emergency care.
After reading news stories about patients literally keeling over dead in the emergency room waiting area having not been treated in time, I kind of wish doctors would treat everyone like they are important, whatever ridiculous complaint they come in with.
As for unnecessary tests, that is an interesting topic for Crohn's disease sufferers as well, as we have many radiological tests performed such as CAT scans and small bowel follow-troughs. We do worry about the cancer causing effects that might be encountered after a lifetime of these tests. On the other hand, a large percentage of Crohn's patients end up having surgery, dangerous complications, malnutrition, and all the pain and misery that goes along with this disease. I guess most of us feel that the risks of the tests are part of the devils bargain we make with the health care system.
Personally, I wonder if my Crohn's might have been diagnosed years earlier if I had been given a colonoscopy or CAT scan at the right time. I don't blame anyone for that lack - I certainly had many tests, but my symptoms presented differently back them and no one thought of an IBD type of issue.
I guess outrage over unnecessary medical tests just seems, well... unnecessary to me. And anyone who has had to argue with their insurance company who stalled about paying for a needed test knows that it is not only in government medical plans that expensive tests are rationed.
Health care is full of grey areas and it's no wonder that Americans are having a hard time making sense of the current proposals. It seems like everyone has a subjective viewpoint. I have the viewpoint of someone with a chronic illness. Dr. Weill has the viewpoint of someone who sells books based on naturopathic and preventative health. An ER doctor has the viewpoint of an overworked, over-sued, and under-appreciated soldier on the front lines of the health care system. It is only by listening to each other and our unique viewpoints that we can come to a consensus that can work for, if not everyone, most of us.
