Short Takes On News & Events

Doctors Think Others Often Prescribe Unnecessary Care

By Jordan Rau

May 1st, 2014, 2:54 PM

Three out of four physicians believe that fellow doctors prescribe an unnecessary test or procedure at least once a week, a survey released Thursday finds. The most frequent reasons that physicians order extraneous—and costly—medical care are fears of being sued, impulses to be extra careful and desires to reassure their own assessments of the patient, the survey said.

The survey was commissioned for Choosing Wisely, a two-year old campaign devised by a foundation created by internal medicine doctors that has persuaded nearly 60 medical societies to identify overused tests and procedures. The goal is to cut back on needless medical care, which by some estimates may waste a third of the $2.8 trillion the country spends on health each year.

The campaign focuses on encouraging conversations between patients and doctors about the suspect treatments it identifies. In the survey, 47 percent of doctors said one patient a week requests something unnecessary. While most doctors believe they are most responsible for interceding, 48 percent said that when facing an insistent patient, they advise against it but still order the test. Another 5 percent said they just order the test.

“I think we’re afraid of not being liked,” said Dr. Donald Ford, a vice president at Hillcrest Hospital, which is part of the Cleveland Clinic Health System and located in Mayfield Heights, Ohio. “We want to be the hero to the patient.”

Not surprisingly, few of the doctors agree with health policy analysts who believe that the financial rewards that come from extra procedures are a major reason why they are ordered. Only 5 percent of physicians said they are influenced by the presence of new technology in their offices. Just 5 percent believe the fee-for-service-system of payment, where physicians are paid for each thing they do rather than a lump sum for keeping a patient healthy, plays a role.

At an event releasing the poll in Washington, D.C., Dr. Richard Baron, the president of the ABIM Foundation, which organized Choosing Wisely, said the campaign’s initial efforts have been a success, with 21 percent of doctors saying they are aware of it and a majority of them saying they have reduced the number of times they order unneeded tests and procedures. The campaign, however, has come under skepticism because a number of the medical societies omitted some of their most controversial moneymakers—such as stents and spinal fusion—from their lists of unnecessary treatments, while targeting procedures that are revenue sources of other specialties.

The poll of 600 physicians was conducted by PerryUndem Research/Communication from Feb. 12 through March 21. It has a margin of error of +/- 4 percentage points.

jrau@kff.org/

15 Responses to “Doctors Think Others Often Prescribe Unnecessary Care”

  1. William says:

    If you can’t trust your doctor to be honest, who can you trust? Shysters! Nothing but greedy shysters! My opinion? If it can be proved, they should lose their license and get prison time for fraud.

  2. mat says:

    Six years ago, I had a colonoscopy. It was completely uneventful. My family history has had no problems in this specialty. I have always had uneventful tests regarding this specialty. I am considered “average” risk in this specialty. That said, my colon/rectal doc told me to come back in 6 years. Lately, I’ve been reading many articles that people with “average” risk in this specialty should get a colonoscopy every ten years. I recently discussed this topic with my primary care doctor and he told me that he is also “average” risk and that he had his last colonoscopy at age 50 and he expects to get his next colonoscopy at age 60. I asked him why my colon/rectal office keeps hounding me to get another colonoscopy after only 6 years. He said, Who knows? Could it be because business is slow and they just want to increase their profits?

  3. blueheronRN says:

    While I know that there are those doctors that hear the cashregister when they order extra tests , my experience has been that most of what is termed as unessesary can be missleading. The above about the colonoscopy frequency is a question within the the specialty. In addition I would agree that a good percentage are “CYA” The very people who would use the term “shyster” would want their pound of flesh closest to the doctor’s heart should they come up with a late diagnosed colon cancer. Time is not money, it is the difference in life and death or the quality of life, so very often. A test that gives a negitive diagnosis (rules out a dangerous, likely diagnosis) is not a useless test. Most doctors, most not all, order the cheapest and most diagnostic tests first. So, what would be my recomendation to patients, make yourself an informed consumer of medical care. Make sure your sources of information are dependable, and accurate. don’t let nurses and doctors get away with not giving you the patient education you deserve. When you pay to laundry your shirt , part of the service is to sow on loose or broken buttons, if your cleaners don’t do this go somewhere else. Likewise, part of the expense of medical care is that you get appropriately educated;too many. way too many medical professionals get away with very poor patient education.
    Ok,about now you are wondering if I have gotten off the subject. No I have not, asking questions, and being informed, and getting to know your provider and being aware of what they are thinking (making yourself part of your healthcare team) Is not only the best way to avoid the “unnecessary,” Is not only the way to get the best level of care, it intigrates the patient so that healthcare is not something done to the patient, but is something in which the patient participates.

  4. blueheronRN says:

    In addition, please, please don’t use terms such as “Shyster” Shyster is a charater from “The Merchant of Venice” by Shakespear. The character has long been a disappointment of a man(Shakespear) people otherwise wish to admire. You see, Shyster was portrayed as evil and in a way that expressed bigotry toward Jews. Even if the doctors are as evil and in the same way as the character,Shyster, you are saying muchmore than that. You are implying a steriotype and hate for the Jews. This is not appropriate in a civil public forum.

  5. Killroy71 says:

    The headline alone made me chuckle. It’s always the other guy. Or the insistent patient. Certainly not FFS. Then why attend seminars on increasing their revenue stream? Surely what’s good for the patient should be sufficient.

    My doctor has recommended tests for me that are inappropriate, based on the latest headlines. Vitamin D testing, anyone? Conveniently done there in the office, where they can capture the dollars. I checked – I don’t have any of the clinical symptoms or risk factors for Vitamin D deficiency. And it’s funny how I never heard that PAP smears are necessary only every 3 years — until I told my doctor my coverage was limited to a certain amount for annual physical. Then why was I getting one every year? And why was I prescribed an antibiotic that cost me more than $100 out of pocket? It didn’t even work – it wasn’t even the right class of medication. A $7 medication prescribed by another doctor worked. Her answer to my questions was: But it’s covered. I changed doctors.

    The insidious thing is that doctors truly think they are above the influence of money – but research shows their actions and their beliefs about themselves don’t match. http://www.ft.com/cms/s/0/283a4104-0820-11e3-badc-00144feabdc0.html#axzz30ZkMR790

    Nurse BlueHeron – I’d like to believe doctors start with the cheapest tests to rule things out, if I had any confidence doctors knew what their prescribed tests and treatments cost.
    http://www.businessweek.com/articles/2014-01-10/how-much-do-medical-devices-cost-doctors-have-no-idea

  6. Seattle healthcare says:

    BlueHeronRN – get your literature references right if you’re going to use them, the character was Shylock. (and Shakespeare was also spelled wrong).

  7. Penelope says:

    Shakespeare aside, I’d be hard-pressed to call a physician a “shyster.” These are men and women who sink 10+ years and upwards of 200,000 dollars into their educations. I very much doubt that a majority of them are in it for the money – most physicians genuinely care about the patients, want to improve the health of their community members, and aren’t suggesting procedures, diagnostic tests, etc. just so they can profit and/or avoid legal recourse.
    That said, physician reimbursement is not the same as it was 30+ years ago. Doctors today pay ungodly sums for malpractice insurance, in addition to their massive school loans, and if you’re a doc that takes medicare/medicaid patients, CMS throw so many loopholes at you that you’re almost never getting reimbursed with what you’re due. Commercial insurers are also getting increasingly squirrely that way. There’s a reason hospitals are seeing an incredible shortage in primary care physicians: no one wants to be one, and it’s for these reasons.

  8. Sam says:

    SEATTLE HEALTHCARE SAYS: BlueHeronRN – get your literature references right if you’re going to use them, the character was Shylock. (and Shakespeare was also spelled wrong).

    Seattle; I was hoping someone would eventually chime in and correct this ignoramus. Actually, the noun shyster is defined as : a person who is professionally unscrupulous…

    William is correct. Furthermore, I suggest that Medical schools graduate “shysters” on a routine basis.

  9. Penelope says:

    I suppose if you’ve made it all the way through med school, you’d have to be extremely motivated – either extremely motivated to do some good or extremely motivated to make some money, in which case it’s unfortunate that you’ll now owe several hundred thousand dollars in student loans. Should have been a stock broker.
    I doubt very much that there are that many money grubbers who’d have wasted their efforts in this way. They should know that there are much easier ways to make a decent living.
    Perhaps it’s naive, but I believe most doctors are in it for the right reasons.

  10. mat says:

    Most are in it for the right reasons? Perhaps…but doubtful. Shylock? Shyster? Yeah…that’s close! Duh!

  11. Caster says:

    I work with a lot of doctors and I think most are in it for the right reasons. They, like the rest of us, are still products of their environments. Most physicians are primarily taught to think about what tests and procedures might be helpful, not the other way around. Choosing Wisely is a physician led campaign designed to shed some light on exactly that — what tests and procedures might do more harm than good. We should praise the campaign as it shows physicians are taking responsibility and working to change their own role in our culture of overuse.

  12. Tammy says:

    Getting Shylock confused with shyster? Aren’t you embarrassed?

  13. Jimmy says:

    I have been a practicing surgeon for 13 years and also have extensive experience in peer review, credentialing, and malpractice as an expert reviewer. The huge majority of physicians perform “unnecessary” tests or procedures due to these motives, none of them which are directly related to greed or other self-serving desires. 1. Malpractice suits. If you DIDN’T do the follow up colonoscopy in 6 years and the patient got colon CA, some lawyer will find a way to blame you, regardless of the 10 year recommendation. 2. It’s how we were taught. Most physicians practice the way they were trained, and it is very difficult to change our ways without some clear evidence AND a strong statement by our specialty professional organizations. Recently there was some evidence that women only need mammograms every 2 years, and from age 50-75. No specialty organization has endorsed this recommendation, however. 3. Seemed necessary at the time to the doc. A test that may be shown by data to be unnecessary in retrospective analysis may very well feel necessary at the time when making a clinical decision without a diagnosis. Much of the “unnecessary-ness” was determined after the fact. Sure that head CT might have been deemed unnecessary when it was found to be negative, but how would you have known the patient’s risk in a trauma situation? Doctors have to make decisions within seconds; they don’t have time to do risk analyses on every patient.
    Bottom line is that just because doctors may perform procedures that might seem unnecessary from 30,000 feet above, it doesn’t always mean that they are careless or have some selfish motive. Even “unnecessary” tests or procedures are usually performed for a good reason. Strengthen our Tort Reform laws and a majority of these will disappear.

  14. Paula says:

    My guess? Doc Jimmy still practices fee-for-service (FFS) medicine. When you practice FFS medicine, there are no risks, right Doc Jimmy? Just keep ordering test after test after test to cover your butt from getting sued, right Doc Jimmy? Even order unrelated tests, right Doc Jimmy? Money is no problem to you, right Doc Jimmy? Test after test after test, office visit after office visit after office visit. Not a problem, right Doc Jimmy? After all, you aren’t paying those bills, right Doc Jimmy? With FFS, you get paid regardless, right Doc Jimmy? The heck with those consumers, right Doc Jimmy? Who cares if they lose their health insurance, right Doc Jimmy? FFS works very well for greedy Docs that have one main concern…getting sued!

  15. mat says:

    Good doc? Bad doc? It does not matter under fee-for-service healthcare delivery. Regardless of performance, they get paid! Would you pay your auto mechanic if your car wasn’t fixed? Well, with fee-for-service, you pay regardless! Like it was said in other posts, this profession is filled with shysters. Why are the good docs so afraid to be paid strictly by performance?

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