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I don't think it is practical at all to order unnecessary tests. It may be necessary due to our tort system, but it is also destroying the health care system via overutilization of tests that have little chance of being positive and almost are guaranteed to be negative. It is substitution of knee jerk reactions for clinical evaluation and expertise. It also becomes self-fulfilling as a system that encourages this type of malfeasance when patients now come to expect from all their doctors the same type of over reliance on tests as did their one doctor who orders batteries of tests. Additionally, the "standard of care" that is so loosely bandied about by the plaintiff's expert witness becomes escalated to the point that a reasonable prudent physician does not stand a chance if he does not order excessive and unnecessary testing.
But we are the shepherds of the financial pursestrings for healthcare in this nation. We cannot bury our heads in the sand and pretend the 13% consumption of GDP by healthcare is someone else's problem. We also cannot be spineless physicians refusing to take any risk at all by doing what is right rather than what we know is useless and costly. People that are risk adverse definitely do not belong in medicine....there are much "safer" harbors for those people such as being a lab technician or a ledger entry clerk.
So how can we rectify the dichotomy of the reality of imminent bankruptcy of the system and the CYA mentality perceived by physicians that want to cover all legal contingencies should they find themselves in court? The issue has to come to the forefront of the healthcare debate by demonstrating how these lawsuits are ultimately restricting care and increasing healthcare bills. Call your congressman one on one...you do not need to recite talking points fed to you by a pain society. Talk to your patients and mobilize them ....give them printed material and tell them to call their congressman's number listed on the paper you hand to them. Your insurers may be very interested in discovering they could reduce testing by up to 90% if tort reform were in play. The medical societies could develop standards of care that include sanctions at the medical board level for those doctors that testify against other physicians and make up their own standards that are unsupported by the literature rather than saying "there is insufficient support in the literature to suggest a particular test should be ordered".
However, after all is said and done, it is unclear that tort reform would alter the patterns of test ordering by physicians. Some doctors just don't give a flip about the solvency of health care system that has enriched them and instead prefer intransigence to expediency. They have enshrouded themselves in the veils of litigious preventative behavior so long that they have forgotten how to diagnose using the tools that were acquired in medical school and residency. They have become risk adverse technicians that find it much simplier to check off a box to order a $3900 MRI rather than do a physician exam and thorough history that show it is not needed. They gave up being doctors long ago, preferring to become entrepeneur and could not find their way back even if they so desired to do so.
So perhaps you are right...it is practical to over order medical tests so that we can sleep at night, knowing we have covered all the bases. The patients that have just lost their homes due to our over ordering of tests may have a different perspective.
Well said. The lawyers write, enforce and interpret the rules. It's unfortunate the patients and physicians are caught in the middle. The sharks get fat while everybody else bleeds. There's no easy answer. You just have to do what you think is right one patient at a time.
