Over-utilizing care, a real problem in health care

I'll answer the question right off the bat - I am not 100% sure as nobody can be. This problem is way bigger than any one person alone could ever fix. That being said there are many issues I encounter on a daily basis in my line of work that are a big problem with health care in this country, when you look at the bigger picture.

Working for a surgeon you are forced to learn the particulars of every physician you answer to. You must figure out what Dr. A wants order for pre-op testing on a patient, what tests they must have had prior to ever coming in to meet with the doctor, which patients they want at the beginning of the day vs. the end, how many patients they want on a Friday, which surgeries you can put where and the list continues all the way down to what coffee they want when they come into the office. This tedious assistance can lead you to discover things you may or may not wanted to have known about a doctor.

In the current health care system there is a huge burden of proof that hangs over doctors heads.

Example:
Patient presents to surgeon with abdominal pain and a CAT scan that shows gall stones. Surgeon explains all the benefits, risks, and alternatives with the patient - always making sure to explain that there is without a doubt pain after surgery. (after all you just got cut open! Pain and a little tiny bit of blood are not that worrisome symptoms in and of themselves)

The procedure was text book and goes without complication, the patient feels fine and goes home. Two days later he is complaining of very slight itching at the incision site.

Now - there are basically two choices; order a test to rule out complication or trust his/her many years of medical knowledge that suggest that slight itching at any wound site is normal as the wound begins to heal. BUT - in the twisted spider web of medicine today - the doctor orders another CAT scan to rule out pulmonary effusion or other post-op complications.

Why? Because if the doctor doesn't and the patient dies many months later of something completely unrelated; he/she could still be held liable to an extent if the doctor could not prove they had taken every single possible precaution after surgery.

/end example

Now that alone sounds a bit harsh - what harm is one CAT scan doing the health care system?

The answer is - very very very little. But look at the bigger picture of the ideology behind it and the mentality it has brought upon doctors today. There are several doctors which I have worked with that have developed a nasty habit of ordering vast arrays of what are quite frankly, unnecessary tests and treatments at the slightest hint of anything.

- patient coughed 2-3 times after he woke up after surgery = doctor orders CAT scan to rule out pulmonary embolism (this is quite common after surgery due to the tube they insert down your throat in anesthesiology)

- patient who had a mastectomy complains of limited range of motion in the shoulder 2 days after surgery = doctor orders physical therapy, massage therapy, neurology consult and home health nursing (any surgeon knows that there is no such thing as pain-free surgery especially mastectomy - it can take many months for the range of motion to return to normal in some people but this particular doctor has actually ordered all that 2 days after surgery)

These are only 2 of the numerous extreme examples of over-utilization of care. Let me be clear however that I am in no way saying that patients don't some times need more care due to circumstances specific to their treatment - of course, everyone is different. Playing it safe by ordering tests is how some doctors do things - it becomes a problem when you see the ones who are ordering large amounts of intensive and costly care for people who truthfully don't need it, and in some cases don't even want it. I hear on a daily basis from some patients "well I don't see why the doctor wants done but I guess he's the doctor"

I also would like to point out this is not my opinion alone, there are several physicians who have said something about the exact situations which I wrote about and agree that they were ordering unnecessary care - simply because it was available.

Even now are you still saying "well what harm is it?" Think about who's paying for it and not just with money either.

The insurance may or may not pay for the care (as is with almost any situation to be quite honest) but no matter what - they monitor and track all the stuff they pay for or are asked to for the simple purpose of tracking trends in care. Insurance companies require review of services that they have determined are being over-utilized by physicians for this exact reason. Insurance companies also charge higher premiums and cut cost of care for people who really need it for this exact reason as well - they have to pay for the staff to review the millions of cases because of the fact that the services are over-utilized in the first place. 


Physicians should not be ordering what they know to be unnecessary care or testing on a patient just because it is available at the time - this drives up the cost of care for everyone in the long run. On top of the bigger picture, more long term consequences - the testing itself may or may not be harmful to the patient (ie. unnecessary radiation, or exposure to radiological agents or dyes) but even if it is unharmful the patients insurance is still being billed and thus the patient still pays for part of that care through copays or coinsurance payments and ultimately through rising premiums.