Wouldn't a doctor who orders unnecessary tests be guilty of malpractice?

[hedgehog]

I mean, what would you think of a doctor that orders a pregnanacy test for an elderly male?
Either the test is useful and necessary or it isn't.

I think this myth of unnecessary testing comes about because most people end up with negative results. Say 10% of the patients with symptoms ABC would be positive for X, wouldn't you still have to test all the patients with ABC to find the ones with X? If X is deadly but treatable, would you test all the patients if only 1% have X?

[SteppingRazor]

1. No.

For there to be malpractice, a doctor's negligence has to break standards in the industry AND cause damage to the plaintiff. An unnecessary test causes no damage, ipso facto, no malpractice.

[Fumesucker]

5. If I have to pay for a test that was totally unnecessary

Then I have been financially harmed at the very least.

Additionally, not all tests are without a physical or physiological price that must be paid, some are very painful among other things.

[Tippy]

6. Take cat scans on Children for instance

X-rays are bad enough but the amount of radiation from a Cat Scan could easilay have a long term effect on small children...When push comes to shove it is a case of a Dr. not wanting to have a law suit brought against him/her or the hospital wanting money...Here is one for you...a patient is brought to hospital DOA...No crime has been committed...Why would X-Rays be needed?...If there is a doubt about the death an autoply will be preformed. Or the family makes the request. These happen all the time

[Alias Dictus Tyrant]

19. X-rays are harmless.

In fact, significantly higher doses than background levels decrease cancer risk (and then increase again as the levels get even higher). It is not a simple linear correlation.

In terms of the radiation bogeyman, ingestion of alpha emitters is what you want to avoid. Medical X-rays won't have a long-term effect on small children unless you give them X-rays daily. They get far more radiation from the environment (rocks, soil, etc) than from X-rays.

[polpilot]

7. Not true. Ordering non 'medically indicated' tests & charging could land a Dr. in jail.

Particularly a medicare/medicaid patient. It's called fraud and WILL impact the doctor. It's a total fallacy that doctors may order ANY tests to 'protect themselves. Not medically indicated, bill medicare, go to jail!!

[SteppingRazor]

9. But that's not the question asked in the OP.

There's a difference between fraud and malpractice.

[laughingliberal]

17. Correct. nt

[Warpy]

2. Those tests were not ordered or done

As a general rule, that sort of thing happens because a rushed coder puts in the wrong code for a test that was done.

However, if there is a pattern of phantom tests and services being billed, it's time to contact your state's AG and turn the bastards in.

I did that on a padded bill. To this day, my record at that hospital is flagged, 3 owners later, and I am offered steep discounts when I walk through the door.

Be nasty. It works.

[OHdem10]

3. Not all, it is done all the time. He can always say I did not want

to overlook anything.

The extra tests do not hurt the patient physically.
Some tests do carry dangers with them. But most often
the hurt is in your pocketbook. High bills to Insurance
Company means in time INCREASES in your PREMIUMS.

[notadmblnd]

4. I think they're just tossng their other Dr. friends business

if an elderly man needs a pregnancy test, they can be purchased at the dollar store for a dollar. However, I'm sure he's probably past his childbearing years.

[wegottadosomething]

32. Sending other Doctor's some business...

While I was residing in Las vegas, the Primary Care Doctor's were a joke. Any symptom would get you referred to a specialist, and if you were hospitalized, not only specialist's were involved, but there were Hospitalist's. Despite all the hands in the pot so to speak, they still could not figure out anything, and refused to communicate with each other. They ordered numerous tests, then would sign off, doing nothing more than increasing the overwhelming medical bills. There were rumors that in order for the Primary Care Doctor's to stay in business, they had to refer a certain number of patients to the specialists. Is there any truth to this? Is this just a big city thing? I certainly don't mind seeing a specialist if it is truly deemed necessary, but it gets a little irritating when you know darn well that your problem could be handled simply with your PCP.

[old mark]

8. It happens every day, many times. It's a traditional way for Docs to make a lot of

extra income from Medicare and Medicaid patients. I have seen it happen with an elderly man hospitalized for a back problem, who was found to also have fluid on one knee. He was literally surrounded by doctors who insisted on testing and "treating" him for every possible malady connected with that knee. It lasted for days, despite the man's objections - the hospital told him they "could not release him" till they had cured all his ailments.
He was on medicare, and this was a private hospital in the early 1980's.
I was the other patient in his room, and even I had an "extra" doctor visiting, till I told him I had no insurance. Never saw him again, but I got his bill.

mark

[hedgehog]

10. I suspect you are describing the real reason for so many

"unnecessary" tests.

Perhaps ordering an unnecessary test doesn't meet the legal standard for malpractice, but it is certainly not good medicine!

I think the statement that doctors order "unnecessary" tests to protect themselves from a law suit is a non-sequitar; either a test in a given situation falls into general good practice or it doesn't. If it's good practice to do the test, then do it. If not, then why would it be malpractice not to do it?

[stray cat]

11. No - absolutely not; it is one way they prevent malpractice and frivolous law suits

[laughingliberal]

15. Has not proven to be the case in the states who have enacted aggressive tort reform

Those states have seen no slowing of the growth of health care costs to speak of.

[harkadog]

33. I would like to see a link rather than your assertion

But tort reform just protects the liability of the insurance companies. It does not protect the doctor. He/she still gets sued and has to go to the expense and time of defending his actions. So unnecessary tests continue.

[michreject]

12. No

Because of threats of lawsuits, a Dr. will order a test even though you had a different Dr. administer that same test a week ago. He will want solid facts to what he's treating.

[laughingliberal]

14. Not totally accurate

States which have instituted aggressive tort reform have not seen a decrease in health care costs related to diagnostic testing. Investigation reveals the real reason for overtesting is physicians who are invested in publicly traded, for profit hospitals and diagnostic centers who profit from this practice.

[michreject]

20. Not everything is a conspirency

I just changed Dr. and when I questioned the tests, he wanted the results in order to arrive at his own diagnosis.

[laughingliberal]

23. Perhaps. But would you expect the doctor to say he owns stock in the hospital or diagnostic center?

I have worked in health care far too long to accept everything a doctor tells me. There may be some cases where that is true. But the investigations done in states where tort reform passed to evaluate why the costs did not come down as promised it is, by and large, the profiting off centers running diagnostic tests by physicians. I'm not sure that qualifies as a conspiracy. I believe it qualifies as good, old fashioned greed.

[michreject]

26. Do you see the irony here?

I have worked in health care far too long to accept everything a doctor tells me.

And yet you castigate a Dr. for not believing another Drs. medical findings.

[Johonny]

27. I think it also has to do with Parients

I know when I was really ill I pressed the Doctors to test anything and everything they could related to my illness. Patients often want extra tests and thus easily fall into the overtesting trap.

[Lagomorph]

13. It's called defensive medicine....

...the doctor covers every conceivable possibility, no matter how unlikely, to minimize the risk of a lawsuit.

[laughingliberal]

16. Please see #14. nt

[northernlights]

18. if a test only identifies a condition in 10% of patients, it's not a good test and not used

The predictive value of tests is more complex than you are presenting here. And the predictive value of any test would have to be way more than 10% to be used.

Any test is going to have some percentage of false + and some percentage of false - results. Tests are evaluated in 5 basic ways before they are approved for diagnostic use:

The diagnostic sensitivity is the ratio of true positives to all patients that test positive (true positive / true plus false positive)

The diagnostic specificity is the ratio of true negatives to all patients that test negative (true negative / true plus false negative)

Predictive value + (test's ability to predict the presence of disease) is the ratio of true positives to all patients with the condition (true positive / true positives plus false negatives)

Predictive value - (test's ability to predict the absence of disease) is the ratio of true negatives to all patients without the condition (true negative / true negatives plus false positives)

Efficiency is the percent of patient's tested that get a correct test result (true positives plus true negatives / all patients tested)

Reference ranges for "healthy" values versus "unhealthy" values are developed by evaluating a large population of healthy people and a large population with a specific condition. Each set of data will (hopefully) produce a bell curve around the mean, and the bell curves of healthy versus diseased populations usually overlap. Within the overlapping area is where you find the false test results, both positive and negative.

Doctors struggle with exactly where to put the cutoff point to indicate the presence or absence of disease, but it cuts right through that overlapping area. If you move the cutoff point in one direction, you get more false positives and more people for whom you will order additional, possibly expensive and risky, tests. If you move the cutoff point in the other direction, you get more false negatives and more people walking around with a disease.

As far as giving an elderly man a pregnancy test, pregnancy tests are actually tests for a specific hormone which in a healthy, sexually active, young female would indicate pregnancy, but in other situations *could* indicate a tumor in the organ that produces the hormone. So yes, you might use a "pregnancy" test on an elderly man if you suspected a tumor in that organ.

And unfortunately while posting this I realized that I got sensitivity/specificity versus predictive values backwards on my test last week. There goes at least 4 points. :cry:

[hedgehog]

21. I was thinking more in terms of only 10% of the patients who

present with a set of symptoms/conditions actually need to be treated for X. Does that mean the test is unnecessary for the other 90%? How do you separate the 10% from the 90% without the test?

[northernlights]

29. if you don't need or want to be treated for "x," don't be tested for it

Presumably you went to the doctor because something wasn't working right. If you don't want that something diagnosed and treated, don't go to the doctor.

Somebody goes to the doctor because they have some set of symptoms. The doctor examines them, gets some more signs and symptoms, takes their medical and family history, and based on that has some ideas about what's going on. The doctor then orders lab tests that will either support the tentative diagnosis or contradict it.

For example, you take your kid to the doctor because of sudden, severe weight loss and dizzy spells. Doctor takes medical history, goes over kid's diet with parent, notes a slightly fruity sweet breath on kid, asks if any family members have diabetes. Does quick and cheap random urinalysis and notes higher than normal blood sugar and ketones. Orders fasting glucose tests to support tentative diagnosis of diabetes. Based on kid's age, family history, symptoms and diet that it's likely type 1 diabetes and goes over treatment possibilities from there. Or based on kid's age, family history, symptoms (say kid is obese, not too thin), and diet, and orders more tests to determine whether type 2 or type 3 diabetes and goes over treatment possibilities from there.

Tests results point in certain direction for presence or absence of condition, and toward what treatment(s) may be possible or most effective (eg diet versus insulin). Or they help determine amount of treatment (eg insulin levels needed to maintain correct blood sugar levels).

Beyond that, I have absolutely no idea what you are postulating about.

[hedgehog]

30. Again, I have never had a problem with the tests the doctor runs.

I'm trying to determine whether the Republican talking point ("doctors order unnecessary tests because of fear of a law suit") has any relation to reality. IMO, either the test is needed or it isn't.

[northernlights]

34. is it possible for a republican talking point to have any relation to reality?

:rofl:

I suspect there are at least as many tests they avoid for fear of lawsuits, if not more. Seriously...the more invasive the test, the higher the risk of injury. Only a sadist would choose to do a spinal tap to invalidate a test...

[cbdo2007]

22. If you don't want the test done, don't get the test done. If you think the doc

is ordering a test that is unnecessary, go get a second opinion and maybe you'll find a better doc or maybe the second doc will agree that you should get that test done.

No malpractice unless they put you to sleep and do the test without your permission.

Sure I felt stupid last year when I found a lump in my breast (I'm a guy) and my doc felt it and told me to get a mammogram. So I paid the extra $75 to go to the specialist to get the mammogram and it was just a small cyst. So was the test necessary or unnecessary? They didn't find breast cancer so I guess it was unnecessary. Do I feel like they screwed me out of $75 and were trying to trick me into getting an unnecessary test done? Nope, I feel like it was worth every penny.

In fact if I pay for 1,000 more tests in my lifetime and they all come back negative...I'll be as happy as happy can be.

[laughingliberal]

24. I have always challenged my doctors on various tests

I am someone for whom mammogram is not that useful. If anything shows on the mammogram, they then order an ultrasound. I have made the case (and won) that we might as well do the ultrasound in the first place. It may be more expensive than the mammogram (I honestly don't know) but it is cheaper than doing a mammogram and an ultrasound.

Of course, a lump in the breast warrants a mammogram. This is not about running legitimate tests. Perhaps, being an RN it is easier for me to spot the duplications.

At the very least, I will call around and find the rates various institutions in the area charge for certain tests. And I will tell the doctor I prefer one center over another. I also ask the doctor when they refer me to a diagnostic center if they are invested in the center and, if they are, I let them know I expect a discount.

I have one friend who was shocked when he called a center his doctor was referring him to for a colonoscopy for a price. He called around and found the charges varied by as much as $2000. He called the doctor and got a referral to the less expensive provider.

[hedgehog]

25. I don't think I 've ever turned down a recommended test myself.

I'm questioning the meme that doctors order "unnecessary" tests.

[TwilightGardener]

28. Most of the time, questioning the doctor about why he (she) wants to order

the test will show what he is thinking, and what he wants to rule in or rule out. If you come in bone-tired and gaining weight, it's pretty easy to understand why he's ordering a thyroid panel, for example. Or if you have achy swollen joints, expect tests related to rheumatoid arthritis or other autoimmune disorders. I've never had any doctor order anything for me that wasn't warranted, even when it came back negative--when you understand what they're concerned about, it makes sense--and if you don't agree that it's a concern, you can opt out.

[wegottadosomething]

31. unnecessary medical tests

Do you know how many pregnancy tests that have been administered to me since my hysterectomy? It is ridiculous! I have a horrible problem with kidney stones, therefore leading to bleeding during the passage of a stone. While in the throes of pain, I do my best to tell the Er docs that this is not a pregnancy gone bad, but still, they run a preg test! It would sure be nice if Dr.s would listen to the patient! Anyway, this website is great! I was just fuming about the Mayo clinic unfairly sending my bill to a collection agency, and I googled the topic, and found this forum. It is great to see many post that share my frustration with the out of control health care situation. Unnecessary tests, like mine and yours are surely one of the contributor's driving up the cost of medical care for us all.