Posts Tagged unnecessary tests
DON’T GET AN ANNUAL EXAM. The data are clear — see the recent article in the New England Journal of Medicine and the op-ed in the New York Times — perhaps you missed this counter-intuitive health advice?
Mechanical devices need preventative maintenance. The aircraft mechanic in the illustration prevents engine failure by checking and replacing parts before they go bad. He knows the MTBF (mean time between failures) for the various engine components. You would think this is how the human body works but THAT’S NOT TRUE. You don’t take out an appendix like a spark plug just because they sometimes go bad — you fix it only when needed because surgery hurts and has complications.
One third of the US adult population get annual physical exams and primary care doctors spend 10% of office visits doing those exams. Sound research shows the annual physical is not needed and worse yet, may be harmful because of false positives (tests that say something is wrong but later are proven wrong). It’s the very essence of a false positive — an abnormal test in a healthy person! You know where that leads: “we need to do some additional tests or a biopsy” — just hope it’s not a brain biopsy.
The US healthcare system needs the wasted 10% of primary care time elsewhere. It’s totally crazy — doctors doing unnecessary annual exams that clog up the appointment calendar and make it hard for people with actual problems to get an appointment. And, a large number of people have health problems who don’t see health care providers when they should (but that’s another story)!
Doctors like to do annual physicals — it’s nice to visit with patients and not have to make any hard decisions. And, they make a lot of money doing the exams under the guise of “maintaining a relationship”. But, the exams are not needed.
A proactive patient would make health care appointments as needed for the following:
- Annual flu shot
- Tetanus vaccination every 10 years.
- Cholesterol test every 5 years
- For women over 40 a pap smear every 3 years and a mammogram every 2 years.
Do you really need to have a health care provider tell you the following things, or is this list enough?
- DO keep weight in normal range (BMI below 25)
- DO walk 30 minutes every day
- DO wear seat belts
- Don’t use drugs or alcohol
- Don’t smoke
- DO Check blood pressure every year (automated checks are just fine)
- DO see a health care provider if you have a health problem.
Keep in mind this discussion is about an exam for nothing in particular — just a “check-up” — which you don’t need. On the other hand, a patient needs visits with a health care provider to treat and monitor abnormal conditions. You need routine visits to adjust blood pressure medications, to treat diabetes, to treat acne and to evaluate arthritis.
Snowbirds: watch out for high medical costs in Florida, Texas, Arizona and California. According to Elisabeth Rosenthal in the New York Times 2/1/15 “Patients Find Winter Havens Push Costs Up”. She points out providers in Florida are the worst offenders — the same place notorious for Medicare fraud!
Ms. Rosenthal highlights one patient from New York wintering in Florida who had a checkup for his pacemaker but did not have any new symptoms. Many in-office tests were ordered by the substitute cardiologist — tests the patient’s regular cardiologist said were unnecessary.
To be very blunt: cardiologists, and other providers, who order in-office tests make a lot of money from those tests. Many studies show providers who profit from tests do more tests than providers who don’t profit from tests. A medical license is not a license to take advantage of patients or Medicare — profit motivation seems to blind some providers to this distinction.
The lure of profit is made greater by a patient not having any new symptoms, not having any record of previous tests, and not having plans for follow-up visits. It is like the patient has a sticker pinned on their back: “TEST ME”. The choice for the cardiologist is simple: either pay the nurse to spend time getting out-of-town records OR make money by repeating tests. Make money, right!
- If you are on vacation and have a sudden health problem your best bet is an urgent care center. They can send you to a specialist, if needed.
- If you have health problems and will be spending several weeks or months away from home:
- Talk to you primary care provider: they may want you to call in and give a report on the phone (diabetes is a good example). If so, no office visit may be needed while away.
- Get enough medication to last the trip. Or, get prescriptions with refills at WalMart or Target and have the prescription transferred to a store near your winter location.
- Identify a doctor to see in your vacation area before you leave. Ask friends or other people who winter in the area for a recommendation. Call the distant provider office and get a FAX number so records can be sent.
- If your primary care provider thinks you need a health care visit while you are away then make an appointment and have your records sent before you leave home — also take a paper copy!
- If tests or surgery are recommended then call your regular doctor’s office to see if they agree.
- Give any provider you see your regular provider’s name, address, phone number and FAX number (a business card is good). Request that results of visits, tests or hospitalizations be faxed or sent to them — and make sure it happens. Fill out a release of information form while you are at the office or other facility.
Jen Wieczner published her article “The Pros and Cons of Concierge Medicine” in the Wall Street Journal on November 11, 2013. Concierge medicine doctors are “on retainer” much like some lawyers. They made a certain reputation as doctors for the rich and famous charging $500 dollars a visit on top of a $30,000 per month retainer. The above Cartier watch ($61,000) was just what they needed to take the patient’s pulse.
Ms. Wieczner now informs us the conciergierie has found a new way to tap into wealth, a patient’s insurance deductible. As it turns out, there are a lot more people trying to be frugal with their health care costs than trying to be extravagant. Those frugal masses are trying to avoid the high out-of-pocket costs for medical exams and tests . In essence, the profitable concierge doctor finds a way to provide less expensive, but very personal care for cash (not insurance) in the environment below the deductible level found in that silver insurance plan. And, as P.T. Barnum said, “there’s a sucker born every minute“.
If it were true concierge medicine has some medical skill not provided by most primary care doctors it would be a wonderful development. But, according the article the wonderful services include PSA testing (not needed), routine blood tests (not advised), testosterone tests (leading to unnecessary and dangerous treatment), x-rays (never an advised screening), PAP smears (really only needed every 3 years), CAT scans (lots of false positives that require more testing), and MRI scans of the brain (for no known reason except the irrational fear of dementia). The claim they can do a colonoscopy for $400 dollars is probably true, the same price as in Europe — perhaps mainstream medicine should take note.
The Wall Street Journal is a forum for capitalist ideas. The notion there is profit to be made in this high deductible world is likely true. Competition to provide low cost care is clearly needed. But, that low cost must be coupled with reasonable, evidence based, coordinated, and quality care. The Timex watch might be a better model for US healthcare than the Cartier watch.