Panel Recommends Fewer Tests

Wednesday, April 04, 2012

Doctors and patient (Seattle Municipal Archives/flickr)

A group of medical boards is recommending that doctors perform 45 common tests less often. Dr. John Santa, director of the health ratings center of Consumer Reports, joins us to discuss the implications for health care and costs.


Dr. John Santa

Comments [15]

Eugenia Renskoff from Brooklyn, NY

Hi, I admire the doctor's honesty in admitting that money to a doctor does matter. The patient should come first, but doctors are human. Eugenia Renskoff

Apr. 04 2012 05:51 PM
Nora Weinerth from Queens

There is, of course, another side to this issue: testing saves lives. I can speak personally to the issue of CAT scans for patients reporting with dizziness. In April of 2009, I was giving a talk at Howie the Harp Advocacy Center in Manhattan, when I began to feel dizzy and disoriented. Audience members jumped up to help me, and called an ambulance. I was taken to Mt. Sinai, where I was questioned and given a routine exam. I told the young doctor about recent, uncharacteristic headaches. I was not given a CAT scan. I was then diagnosed with “syncope”—fainting; I went home on the subway. Three weeks later I collapsed, not breathing, no pulse. My husband gave me CPR and called an ambulance. At the local hospital, I was given a CAT scan, which revealed a massive burst aneurysm in my brain. My husband was told I had little chance of surviving. Fortunately, I was then taken to North Shore University Hospital in Manhasset, where I was operated on by two extraordinary surgeons, David Chalif and Avi Setton. After six months in hospitals, and three years of rehab and recovery, I am alive and well—and very angry about the way aneurysms go undiagnosed in this country. There are an estimated six million people in the United States with a brain aneurysm; many of them will die. Experts on aneurysms now believe that any headache or dizziness severe enough to take someone to the ER deserves a CAT scan or MRI. We know now that my initial dizziness and headaches were caused by what is called a “sentinel bleed” from an aneurysm about ready to blow. If I had been given a CAT scan on that initial visit to the ER, it would have revealed the aneurysm immediately. I might then have been wheeled into the operating room, where one of Mount Sinai’s excellent neurosurgeons would have performed the new, non-invasive “coiling” procedure on the aneurysm, and I would have walked out of the hospital a week later, on my way to a rapid, full recovery. As it is, though my survival is a miracle, I am still learning to walk. A little money was saved by not giving me that initial scan; but well over a million dollars has been spent by my insurance company on my brain surgeries and recovery. Surely not scanning for brain aneurysms is a false economy.

Apr. 04 2012 12:01 PM

Brian from Hoboken:

Think I read that same article in Bloomberg a while back. Was real good and eye opener like you said. Really showed the reality of the tough decisions faced by the health system and why it seems to be a hard conversation for our society to have in an objective manner.

Apr. 04 2012 11:11 AM
Louise from Brooklyn

I take issue with the recommendations concerning colonoscopy screenings. My first screening at 50 was negative, but my 2nd screening, five years later, showed polyps which needed to be removed. If I was required to wait 10 years for another screening, those polyps may have developed into colon cancer. Now I am required to return for another screening in 3 years. Ten years is a long time to assume that someone is not at risk. I don't love having to take these tests, but I think we need to be cautious about letting the pendulum swing too far in the other direction.

Apr. 04 2012 10:53 AM
Lynda Myles from Manhattan

There is also the problem of under-testing in certain medical situations.
Few people are aware of the issue of "breast density" particularly among a large percentage of pre-menopausal women, but also among post-menopausal. Radiologists who send women their mammogram reports saying the results are "normal." They will send another report to the referring gynecologist saying,in effect, "normal, but so dense can't be certain nothing's there." It is not custom for the gyn to pass this information on to the patient and advise them to get further testing -- especially where there's a family history. Connecticut has passed a law saying women have to be told, but insurance companies are fighting it in other states. I have personal experience of this situation with a close relative.

Apr. 04 2012 10:50 AM
Brian from Hoboken

I can't wait to hear how this is reported by Fox et al. Something tells me that the fact that the recommendations are made by the thought leaders on the boards of the appropriate specialties will not be reported. Instead it will be Obamacare and death panels all over again. This country is unable to have an adult conversation regarding end of life care. Not fact checked but I think the figure is close to 40% of wealth care costs are for the last 6 months of life. A Time journalist did a personal story about this regarding her father's kidney cancer. It was a real eye opener.

Apr. 04 2012 10:42 AM
John A.

I toughed it out and declined a program of tests that would've included a CT And an MRI. Saved about $12K, Plus some radiation exposure (perhaps that should have been mentioned).
I have to add that the condition was not in a sensitive organ, nor was it cancer - but the condition went away completely with some careful management and one Ultrasound ($500) test. I no longer go to that doctor with the AMG and the corner office, have a nice day sir.

Apr. 04 2012 10:42 AM
Sheldon from Brooklyn

Extra tests are not only about getting extra money - it's about doctors protecting themselves from lawsuits. Until we have tort reform - this is a moot issue.

Apr. 04 2012 10:38 AM

How frequently should blood work ups be done ? How much change can occur in a normal healthy middle aged person ?
I have been to two different doctors within a 6 month period, and each demanded full blood work ups !
Why could one not use the results from the other ? How often do the results change enough to need retesting in 6 months ?

Apr. 04 2012 10:38 AM
Anne from Brooklyn

As a primary care physician, I applaud this report. Unfortunately, in our for-profit health care system, a lot of people make a lot of money by doing these tests. Physicians who perform the tests, including radiologists who read studies, make money. Free-standing radiology centers make money. Hospitals depend on a lot of these tests to fill gaps in their income. In order to reduce the use of unnecessary tests, we need to change our reimbursement system. Physicians should be salaried and not make money by doing more.

Apr. 04 2012 10:36 AM
Karla Fisk from Inwood, NYC

In some cases, unnecessary tests can do great damage. My father, at age 79, living with Parkinson's at home and still ambulatory, was ordered into the hospital by his heart doctor for tests. (My mother didn't know to object) While there for three days, he was hooked up to machines and lost the ability to walk, because no one in the hospital made sure he got up and walked every day. This resulted in him being moved directly from the hospital to a nursing home.

It was truly tragic and unnecessary.

Apr. 04 2012 10:35 AM
Jessica Pellegrino

I had a ganglion cyst removed last week (at Yale Medical Ctr in New Haven). In an exam the week before, the surgeon closed the blinds and used a pen light to examine my wrist. He cheerfully announced, "That was the poor man's MRI. Or I could send you for one and bill your insurance company $1,200." I appreciated his low-tech approach! The full anesthesia and operating theater for a minor outpatient surgery, on the other hand...

Apr. 04 2012 10:35 AM

My NYC cardiologist does an ecg every visit. WHen I look at his reimbursement from the HMO he's in,(billed, $550 payd $125) is a fraction of what he bills. How can he pay overhead in NYC without these extra procedures?

Apr. 04 2012 10:34 AM

AARP is an insurer!!! Don't quote them as objective entity!!!

Apr. 04 2012 10:34 AM
mary from clinton hill

Please comment on mammograms. I am the only person I know who cheers the recommendations for fewer, less frequent mammograms. the science makes sense to me, but people get emotional about this and think I'm nuts.

Apr. 04 2012 10:32 AM

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