Wednesday, September 16, 2009

The Web Of Excessive, Unnecessary Medical Testing

Below is a personal account by physician Jack Coulehan that appeared in the recent issue of Health Affairs journal:

Shingles Does It, Health Affairs, Sept/Oct 2009
"After a doctor-professor with a bad case of shingles arrives in the ER, he discovers what it’s like to be a patient in pain during this age of aggressive medicine."

Dr. Coulehan is professor emeritus of preventive medicine and senior fellow at the Center for Medical Humanities, Compassionate Care, and Bioethics at Stony Brook University, NY. He advocates against excessive medical testing. Given his position and experience, he "felt fortunate that there was absolutely no way I’d ever be stuck in such a scenario."

Stuck he was. On Easter morning, 2008, while experiencing intense pain from shingles, Coulehan visited an emergency room to confirm his diagnosis and get prescriptions. He left 12 hours later after seeing 2 physicians, a neurologist, an ophthalmologist, and undergoing 2 MRIs and a CT scan of his head. The hospital ER bill: $9000.
"By the time I learned the total of that ER bill, I’d also come to grips with my feelings about the Great ER Caper. At first I felt angry and embarrassed about spending a whole day at the hospital, subjecting myself to multiple expensive and unnecessary tests and playing along with the culture of medical overkill that I’ve spend decades teaching students to avoid. How stupid!"
But he realized what he was up against - entrenched profit-based medicine:
"In today’s medical culture, we almost always consider that more is better. Each new machine creates pressure to expand the ways it can be used. In most health care settings, the doctor has far greater incentive than disincentive to order excessive services."
And the trust we are compelled to place in that system when we fall ill:
"I learned how difficult it is to remain objective when you’re feeling very sick."


Anonymous said...

I had a somewhat similar experience with a visit to an urgent care clinic because of back spasms. The physician assistant insisted on several blood tests and an x-ray of one hand - as I had a slightly swollen joint in one finger. I tried to decline the x-ray but he insisted and the message was clear - do it or leave. Only after reading the x-ray did he take any note of the back spasms - which he pronounced due to a "virus" and said the spasms would be gone in 2 weeks and gave me a prescription for pain medication. The finger has some arthritis - well - whoopy - I already knew that - the bill for all this - to medicare and my supplemental insurance - more than $1000. Next time I will stay home.d

Clamence said...

The doctors are ordering these "unnecessary" tests to protect themselves from malpractice while being paid at the same time.

Don't let this distract you from the real issue: "the lie" that these tests or physicians time cost anywhere near $9000 dollars.

Lets say physicians are "worth" $500,000 a year. That means an hour of their time is roughly $250/hour.

Seeing 2 physicians and two specialists = 2-4 hours of time = $500 to $1000

A $5,000,000 MRI machine can do ~10,000 MRIs a year for 2-3 years, so they're about $200 a pop (max), plus power ($50 max), plus the tech's salary ($50) for a total cost of $300.

Assuming the CT costs as much as an MRI, a very high estimate of the actual costs of this guys trip is around $2000 at most.

He was billed $9000, this is a profit margin of over 300%, no other large scale industry in the world operates with this sort of margins, this is what is really criminal.

Keijan said...

Most back muscle spasms are from straining weak muscles. Usually the pain dissipated in about 2 weeks no matter what the treatment. Some mild pain killers and staying active help. There are lots of remedies out there that usually work in about 2 weeks. Lots of money is spent on bogus care that works in about 2 weeks. What is a back “virus”? Seems like a catchall term for unknown causes, like a stomach “virus” or a “virus” in the neck.

Bix said...

"I tried to decline the x-ray but he insisted "

Interesting. I've been going to the same dentist for 17 years. The last visit, after I declined x-rays, which I had done occasionally in the past, I was told I had to sign a waiver releasing my dentist from liability. That was new. The pressure to sign it was also new.

Anrosh said...

as clamence puts it above " the profit margin is 300% ". a neurologist in ny city costs $460 without insurance.

may be one should have a study on how the medical industry is driving bankruptcies.

Bix said...

How do we make healthcare more affordable?

Anrosh said...

catch the insurance guys - they are the one's who make these payment models.

- and a doctor was once telling me though there have been some inroads into certain diseases, doctors are scared in using this information - doctors work with the centre point of malpractise insurance - how dangerous is that.

some doctors can just want you to put a chip in your heart ( just in case - he is a super specialist -- they all have committments to the hospital board to bring in certain amount of money.

when health becomes a business and a business man looks at health , it does not become looking after ' health " but the pockets of share holders.

business men are only interested in creating bigger wallets not in the nuts and bolts of health.

when i first came into this country i did't know how it all works, then i met a lawyer , who was a complete stranger , who sat me down and told me some of these things.

many other doctors told me how to communicate with doctors - asking them explainations on why a certain test etc etc ...i think all this should be taught as life lessons in schools (as we teach money to the kids ) - but for your question on how we make this affordable, lets catch the insurance guys - and all those ph.d's who 's taking their 5 year worthwhile work and putting it for the benefit of the insurance empires, instead of being put to better use.

too many physicists and mathematicians enticed into this- this green seems to be very attractive, eh ?

All roads of american health is towards the 9/11 road.

i am trying to persuade a certain somebody to get to a bottom of this if he plans to continue with a ph.d - i am only keeping my fingers cross.

i am sure the readers know this and more...

Bix said...

I agree 100% that profit margins are doing us in. Now what?

Interesting point Clamence, would we call the tests "unnecessary" if their cost was less, or invisible?

Medical Aesthetics Jobs said...

The keyword that gives the whole scam away is "TREATMENT". We go to the hospital to be treated, not to be cured. I can't begin to imagine what kind of fuel is being used in an ambulance that that charges me $950 for a 2 mile ride. I know they are making massive profits on each test they perform, but unfortunately the doctors don't get to see any of it. I believe that doctors are getting played with just as much as the patients, and are being denied vital information to properly CURE their patients.