Panel recommends a second opinion on medical tests

Sarah Gardner Apr 4, 2012

Sarah Gardner: We all suspect it but now doctors are saying it. A lot of the medical tests that physicians order are unnecessary and add hundreds of millions of dollars to the annual cost of health care. Nine medical boards today named 45 tests and procedures that should be performed less often, everything from repeat colonoscopies less than 10 years after the first one, to early MRIs for moderate back pain.

Dr. James Fasules is with the American College of Cardiology, one of the medical boards that put out these new guidelines. Dr. Fasules, welcome to the program.

James Fasules: Thank you.

Gardner: Why is this happening? Why do doctors order these tests if they are unnecessary?

Fasules: I think it’s two things: It’s one, expectations of patients; and another, it tends to be the clinical habits of the community. A big part of today was patient education because a lot of the studies are done up because of patient expectation. We’re in a society that thinks more is better, and in this case, more doesn’t necessarily help in your diagnosis. It may actually lead to going down the wrong paths and be detrimental.

Gardner: I think a lot of patients assume that part of this is one, fear of malpractice; and two, that doctors can make more money if they order more tests. Is that not true?

Fasules: Yeah. I have to say that it’d be true for both, but I would also say that what the doctor really wants to do is take care of the patient. And the first thing they do when they get up in the morning is not think how many of these studies they have to do to make money for that day — they want to do what’s right by that patient. Now, the malpractice issue kind of gets inculcated and ingrained into the habit of the community. But what we’re talking about is upwards of $300 billion a year that are tests that don’t lead to any improvement in the care of the patient. And that’s a big chunk of buck when you look at it.

Gardner: You know last time a government panel came out with guidelines suggesting less testing — and this had to do with mammograms in 2009 — it created a real political backlash for the Obama administration in charges of rationing care. Are these recommendations a form of rationing?

Fasules: Not really. They are helpful to make the right decision at the right time with the right patient, and shouldn’t be viewed as neither rationing nor as directing care of the patient. If they really need that test, by all means go ahead and get it, but by a thoughtful process for obtaining these tests.

Gardner: Let me ask you, from your experience, you work in pediatric cardiology. I’m just wondering if some of this — a lot of the patient pressure — is it coming mostly from older patients or is it across the board?

Fasules: Well I think it’s across the board. I always joke that the most difficult thing when I was teaching the residents is always having someone in the room who knew more than you did, and that was the mother. So the mother has a lot of the — sorry about that — but the mother has an expectation about what the care is, and we’ve become a society that almost feels you can’t make a diagnosis without a test.

Gardner: Let me go back real quickly to what you said — I have to defend mothers.

Fasules: I have a mother, and she’s going to hear this.

Gardner: Because I probably have been one of those, pushing for more tests once in a while. My experience is that people push for more tests because sometimes they’re not given enough information by doctors, and an explanation of why they’re not giving the tests.

Fasules: Exactly. I think that’s the next step here — that we actually put tools together that can be used by the physician with the patient in the room. But I think the real helpful thing would be a tool that’d be on like a laptop or tablet that the doc can take in to the family and actually show this is what’s going on, and this is what we’re going to do. And if they ask about the tests, you can actually pull up the guidelines, the appropriate use criterion, and say these aren’t really needed right now, we’re going to be doing this instead.

Gardner: Dr. James Fasules is with the American College of Cardiology. Dr. Fasules, thanks for being with us.

Fasules: You’re welcome.

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