Doctors, why so many tests?!!!?

I am also a radiologic technologist, and I also get frustrated with all the seemingly unnecessary exams. I also believe it is due to lawsuits. Many doctors use the CYA (cover your a**) approach. I also notice that the younger doctors order more unnecessary exams. It is as if they are unsure of themselves. The older doctors are better at practicing medicine....they have been around long before MRI, CT, ultrasound etc. was around!

I don't think it has much to do with the doctors themselves making more money. A doctor who refers a patient for a CT or MRI at an imaging center does not make any money from it. The imaging center makes the money. And, as you know, an imaging center's radiologist cannot order an exam on a patient, as this is conflict of interest.

I get frustrated with the 90 year old women, who are in the last stages of lung or heart disease, and here they are for their screening mammogram! Or the patient who is dying of metastatic cancer who comes in for a DEXA scan. Or the morbidly obese patient who comes in for a knee MRI (hmmm, wonder why their knee hurts?!?!?). In these cases, these patients are not candidates for surgery or they are going to die in the near future (sad, but inevitable), so what does it matter if they have an early breast cancer or osteoporosis or a torn meniscus?

I am not a dr but work close enough with them to come up with a bit of an answer.

avoiding lawsuits

people are damn sue-happy, so if there is something wrong and that pedal edema is really a DVT and the dr didn't order dopplers done the dr's butt can get a lawsuit slapped on it real fast. If that DVT goes PE then the dr is even more up crappo creek. They want to keep their own butts covered because malpractice insurance is expensive enough.

Plus how do you know the pt's whole history. I am rather sure then when I got a few of my tests done the techs thought it rather insane- but they were necessary. Then again I am a very informed pt and my dr will talk about why he orders everything (otherwise he won't be my dr long). Perhaps more people should ask the drs why they are getting these tests, and if they don't want them done then they can refuse them

The difficulty in the practice of medicine is that the ailing parts cannot just be properly examined thru direct visualization. Its like asking a mechanic to check and fix on the problematic engine while it is running. So there is never a 100% sure thing in making a diagnosis. If perfection cannot be achieved thru physical examinations, the doctor seeks other procedures that wld assist him to coming up to a diagnosis closest to what he thinks is right. Remember that the mode of treatment always depends on the diagnosis.

Another factor is that because of the imperfection to making a diagnosis, doctors are always on the risk of legal implications like medical law suits. Patients often times contest the doctor on the reasons why further tests were not done. Additional test are normally done in relation to the diagnosis in mind. So if the doctor initially comes up with the wrong diagnosis, he will definitely miss the right ancillary procedures necessary to make the right diagnosis.

So to prevent these complications and to avoid unnecessary legal suits, doctors today are practising safe medical practice by requesting for every possible test that is related to the symptom. This definitely will tantamount to high cost of medical care. This is also the reason why health insurances came into existence.

Another problem in today's medical practice is the development of specialization. Doctors practising their specialty often times concentrate on the areas of their specialty and neglect seemingly "minor" symptoms and signs that may be considered as impt to other specialists. A holistic approach is the best since the human body functions as a single unit with every system being interrelated.

Well if one patient in 100,000 with CHF and pedal edema had a DVT that becomes a PE, then in a country as enamored with litigation as ours, you better believe every possibility is going to be ruled out to avoid any disastrous outcome, regardless of its unlikeliness. If medicine was just about cost-effectiveness and risk-benefit without the added need for cover-your-*** testing, then this problem wouldn't exist.

I think frogsandducks is right there. She has a point. If patients are indeed sue happy, then the docs out there wont take any chances but will try to rule out any possibilities with their patients.

This is not the case here in India, we ask the patients to test only when doubted for certain illnesses and not all tests.

well, between insurance being such a scam and people getting sued all the time it is no wonder. also, it keeps the poor from getting what they need. like we can afford all those tests.