I think Obama is missing a key point.

[Barack_America]

With the redundant and unnecessary tests, the point is not only to reduce costs, but to reduce risks to patients.

Every diagnostic test comes with a certain degree of risk that the test will do more harm than good, that a complication will occur that is more harmful to the patient's welfare than the results of the tests are beneficial to the patient's welfare.

For example, x-rays and particularly CT scans expose patients to radiation. Every blood draw carries some risk of infection, a blown vein, etc. Every urinalysis, well, I can't quite think of the risk associated with peeing in a cup other than peeing on your hand, but that's probably bad enough.

The point is that doctors have developed a bad habit of ordering tests instead of conducting thorough history and physical exams on their patients. They've developed these habits in part because ordering tests is both profitable and easy for the doctor. But is this practice better for patients? I would argue no. I would argue that patients would be better served by doctors spending more time with them, asking about their symptoms and conducting thorough physical exams, rather than just punting care to diagnostic labs and specialists.

With that being said, physicians don't practice these behaviors just because they're lazy, they practice them because insurance companies often allow doctors to spend so little time with their patients that all they have time to do is fill out scripts and referrals. That needs to change too.

In any case, I think that Obama should begin to phrase the argument against excessive testing not only as being too expensive to our health care system, but also as not in the best interest of the patient.

Thanks for hearing me out.

[DesertFlower]

1. exactly.

i recently went to an orthopedist. he insisted i have another x-ray even though the results of my x-ray and MRI were being faxed to him by my primary care doctor. the x-ray lab was part of his office -- so he was going to make more money and bill the insurance company again and yes, i would have been exposed to more radiation.

i said "screw it" and i walked out.

[Barack_America]

2. Yes.

Sometimes there is justification for this, i.e. wanting a different view on the x-ray than was done previously.

But if the doctor hadn't even looked at the previous x-rays or reports, the motive is most likely money.

[scheming daemons]

3. It won't sell to tell the public he's for "reducing tests". The public want their damn tests.

[Barack_America]

5. Just like they want their antibiotics for viral infections.

If he's going to raise this point, and I wish he would, I think the obvious example is x-rays and radiation exposure.

But with regards to demanding tests, I think that if doctors are allowed to (and do) spend more time with their patients, people will become less demanding of tests. I think a huge problem right now is that people don't think their doctors are actually treating them and that if they don't walk away with a prescription for something, then they haven't actually gotten care.

[Coyote_Bandit]

4. Doctors

are often required by their employers to meet patient quotas. That results in scheduling requirments which ermit a doctor to spend no more than 5 or 10 minutes with each patient.

[Barack_America]

6. And the quotas are based on "billable time"...

Which is determined by insurance companies.

If we start allowing doctors (or their employers) to be compensated for actually treating patients, they will.

[OHdem10]

7. Also the system is designed so the more proceedures a Doctor

does, the more he is paid. They can make out like bandits
with private insurance plans.

This is why so many Doctors refuse to take Medicare Patients
and limit when they can Medicare Advantage. Medicare and
HMOs will permit only Medically Necessary Tests and Proceedures.

In Ohio many Doctors have signs Do not accept Medicare.

[Barack_America]

8. That's why the public option is so necessary...

It will help keep costs and, therefore, premiums down.

Doctors with these sorts of business practice will soon be out of business.

Any doctor with a "Do not accept Medicare" sign is not a doctor I would want to see. We're patients, not cash cows.

[EmeraldCityGrl]

9. Obama can't put himself in the position of stating what is best in regard to

patient care. That's a decision for doctors to make. He's reforming health insurance, not patient care.

[Barack_America]

10. That is a fair point.

But I don't see the harm in him quoting studies that have been done about repetitive tests and the risks they pose to patients. This is a fairly well-studied area.

[dflprincess]

11. Unfortunately, there's nothing being done to keep the insurance companies,

not the doctors, from making the decisions.

[Edweird]

12. This is better left unsaid. Idiots are already screaming about 'death panels'.

This will bolster their position.

I also don't agree with your position. Doctors have to diagnose and treat illness. To do this, they need information the way they need it.

Furthermore, if a test was performed incorrectly or incompetently by someone else and your doctor uses that information and the incorrect conclusion is reached, he will still be held responsible.

Would you accept 'I went by the results those other guys gave me' if he misdiagnosed you?

[Barack_America]

13. There are more ways to gather that information...

Than just expensive and sometimes risky diagnostic tests.

P.S. I'm a med student.