There’s a great piece in today’s Washington Post by medical doctor and Stony Brook University professor,
Jack Coulehan—one perhaps as notable for what it doesn’t say as for what it does.
In a nutshell, Dr. Coulehan woke up one Easter Sunday with what experience told him was a nasty case of shingles. Since it was Easter Sunday, the doctor elected not to call his internist or one of his partners for the prescriptions he needed, but instead, to visit the emergency room of the teaching hospital where he worked.
Thus began what Coulehan referred to as the “Great ER Caper.” The physician on duty quickly and accurately diagnosed the shingles, but for “completeness’ sake,” brought an ophthalmologist and neurologist over to have a look too. Twelve hours, $9000, an MRI and a CT scan later, Dr. Coulehan (who said he felt like he’d been “conned” and “manipulated”) put a stop to charade, demanding the meds he’d originally come for and making his retreat.
Now here’s where the story gets especially interesting. As Dr. Coulehan conveyed the moral to his harrowing tale, there was no mention of “lawsuits” as the reason for his unnecessary tests—but instead, as with Texas, the culprit was overutlization—the real contributor of costs within the health care system.
Here’s how Dr. Coulehan explained it:
In a nutshell, Dr. Coulehan woke up one Easter Sunday with what experience told him was a nasty case of shingles. Since it was Easter Sunday, the doctor elected not to call his internist or one of his partners for the prescriptions he needed, but instead, to visit the emergency room of the teaching hospital where he worked.
Thus began what Coulehan referred to as the “Great ER Caper.” The physician on duty quickly and accurately diagnosed the shingles, but for “completeness’ sake,” brought an ophthalmologist and neurologist over to have a look too. Twelve hours, $9000, an MRI and a CT scan later, Dr. Coulehan (who said he felt like he’d been “conned” and “manipulated”) put a stop to charade, demanding the meds he’d originally come for and making his retreat.
Now here’s where the story gets especially interesting. As Dr. Coulehan conveyed the moral to his harrowing tale, there was no mention of “lawsuits” as the reason for his unnecessary tests—but instead, as with Texas, the culprit was overutlization—the real contributor of costs within the health care system.
Here’s how Dr. Coulehan explained it:
Each new machine creates pressure to expand the ways it can be used. In most settings, the doctor has far greater incentive than disincentive to order excessive services -- that is, those that aren't indicated by practice guidelines or evidence-based medicine.
How can we make stories like mine less common?
The only way is an approach to health-care reform that encourages well-coordinated, standard-of-care practice and simultaneously discourages the irrational, shotgun approach to medicine.
Nice post. Agree that there are many reasons why we physicians order tests with abandon. Patients like it. It keeps the office schedule moving. It offers some measure of litigation protection. We make more money. We want to feel as if we are skilled practicitioners in modern technological medicine. And,we practice excessively because this is the culture of medical practice today. More of the good, bad and the ugly in medicine at www.MDWhistleblower.blogspot.com
Posted by: Michael Kirsch, M.D | October 13, 2009 at 09:39 PM