Dangerous Decisions – Why Doctors Order So Many Tests

Commentary by Dr. Michael Wald

Contact: 914-242-8844

An article occurring in the New York Times, Sunday October 2, 2011 edition, discussed this important issue.  Dr. Wald’s comments in black below.

The article goes on to say that doctors admit performing tests because some patients seem to insist on testing when they have chronic symptoms.  Other causes include:

Staying out of trouble and surviving in medical practice  – doctors are performing tests to help offset malpractice cases.

Financial reasons – Most doctors did not report that this was a motivation.  This of course does not mean that money making was not part of their decision to perform tests. In my opinion however financial gain is actually not a prominent reason by the individual health care provider, but might be on the part of their employer (i.e., the hospital and/or HMO/PPO who drives testing criteria).  It is my believe that many practitioners are actually ignorant to the harm that many procedures/practitioners can inflict upon their patients (such as too many x-rays, mammograms and CT scans, or medication prescriptions).  I believe that most medical physicians actually believe that they are doing the right thing for their patients in terms of medications and medical tests even and have not thoroughly thought out for themselves the negatives.  They are simply “doing what they are told” or doing what they were taught in residency or medical school and do not often think creatively or “out of the box”.

It should be noted, according to the New York Times article, that some studies have estimated that up to 30% of the care delivered to patients in the United States is unnecessary, and sometimes even harmful.

Patients are receiving too much care.  This believe, according to many doctors themselves, underscores the issue of too much care, increased chances of complications including unnecessary deaths, side-effects and other issues associated with unnecessary interventions (i.e., x-rays and CT scans that may contribute to cancer incidence).

Surveys show that doctors feel pressure to overtreat patients based on inadequate time allowed to consult with their patients, fear of being sued or being perceived as not doing enough and ordering tests for minor issues.  The problem here in my opinion is that patients insist on more attention within a disease care system (and not a health care system) – this philosophical and practical difference often leads to trouble.

A survey of doctors said that they, “believe that the current quality measures and clinical guidelines endorsed by healthcare experts and insurers has a way to reign in excesses, where, in fact, has the opposite affect.  The guidelines might, for example, require patients with high blood pressure and diabetes to have specific blood tests every three months…”  What this statement is saying is that the insurance companies often dictate practice guidelines for doctors that may lead to overtreatment, medical complications and unnecessary medical care.  One must also keep in mind that the medical treatments for these and other conditions that are tested, due to medical policy, on a regular basis, may lead for many people only to the “standard medical management” (which may be dangerous) when so many safe and natural alternatives are available.

“Guidelines in general set a bar for not enough care” – Some doctors claim that more testing should be done, but studies have shown that the more medical care delivered the greater the number of complications. Also, according to the New England Journal of Medicine, 80% of procedures and practices in medicine are wrong!  According to other studies, most diagnoses are wrong; if this is true than 100% of the medications prescribed for these wrong diagnoses are incorrect!

 “Moreover, a majority of doctors surveyed acknowledge being curious about how their colleagues practice; and well over half ask to see a report and the researchers offered on how practices in their own communities differed from others”.  I find this statement unbelievable because doctors should know something about other areas of medicine.  This is a problem I believe in the basic medical education that is compartmentalized meaning that different doctors studying different types of medical care are often undereducated in other areas of medicine.  This underscores a major criticism of holistic doctors and practitioners that have knowledge in medicine, natural medicine and all areas of the body.  Remember the old saying, “One can be too close to the tree so as not to see the forest”; this statement I believe is true of medicine and is a major limiting factor preventing wellness care delivery to the public.

What this article completely ignores is the fact there is almost a total absence of tests and procedures which are meant to prevent the major causes of death and disability in this country.  Furthermore, these tests, otherwise known as bio-markers and nutritional tests, when considered in a holistic fashion, can go a long way towards prevention saving literally billion so of dollars and millions of lives; and improving quality of life. 

 No one is claiming that holistic care, when done right is inexpensive, but in the long run people undoubtedly live higher quality lives and may even be living longer as a result of a reduction in chronic degenerative incidence.