| Say you have a bad back. And say I give you $3,000. | | | | sued, or a patient may suffer, or we may be accused |
| What do you want to do? Your back really bothers | | | | of rendering insufficient care. We don't want to be |
| you. You've missed a week of work. Most days you | | | | responsible for healthcare rationing, nor of treating |
| take a few ibuprofen. Sometimes the pain goes down | | | | patients unequally. |
| your leg. Your doctor suggests an MRI. Do you take | | | | Patients want the best treatment - especially if |
| that $3,000 to the hospital, get the MRI, and learn how | | | | someone else is paying - insurance, Medicare, |
| badly your back has deteriorated? | | | | Medicaid, the VA. But ultimately it is our money, our tax |
| "My insurance should cover that," you exclaim. But think | | | | dollars. Getting expensive tests will never result in |
| for a moment. As far as you're concerned, the test is | | | | lower insurance rates. The money your employer |
| free. I just gave you $3,000. But no. You'd like to visit | | | | pays toward your insurance is really your money - you |
| Hawaii. Or pay off your car. Or take a vacation with | | | | just don't see it. |
| the kids. You shouldn't have to use your $3,000 to pay | | | | "But I want to know," some patients say, regarding an |
| for a medical test! And there's the crux of the problem. | | | | MRI of their back. But what if the test makes no |
| In the medical field, everybody is spending someone | | | | difference in the treatment or the outcome? Do you |
| else's money. The test would be worth it to you if | | | | really want to know badly enough to take that $3,000 |
| someone else were paying. But if you have to part | | | | and hand it to the hospital administrator? |
| with $3,000 in cold, hard cash, somehow the test | | | | Americans have come to believe in testing rather than |
| doesn't seem quite so necessary. | | | | clinical judgment. We'll believe an x-ray before the |
| Theoretically, insurance covers tests that are | | | | educated opinion of a physician. Somehow it's |
| "medically necessary." If your doctor says you need it, | | | | consoling to see a black and white report. And doctors |
| you must need it. Not necessarily so, I say. What if you | | | | are not immune. It says so right here, in this report, a |
| would not consent, under any circumstances, to | | | | doctor may say to bolster his or her own conclusion. |
| undergo back surgery or epidural injections? What do | | | | America, we need to change. Doctors and patients |
| you gain with an MRI? | | | | have to trust each other. An MRI of the back is only |
| There are currently 100,000+ family physicians in the | | | | one example where significant savings are possible. If |
| U.S. according to the American Academy of Family | | | | your doctor orders an MRI (or CT scan) ask what will |
| Physicians. What if each of us ordered one less MRI | | | | be gained. Will it affect treatment? Will your outcome |
| this year? That could equal $300,000,000 in savings. It's | | | | improve? Often the answer is no. And is it worth |
| fairly easy to see why insured patients consent to | | | | $3,000 to you? Quite frequently, there are less |
| tests of borderline necessity. It's not their wallet that will | | | | expensive options. Why not take this article with you |
| suffer. | | | | to your next appointment and see if your doctor |
| But why do doctors order tests that may not be | | | | agrees. |
| strictly necessary? The reasons are numerous. We | | | | Copyright 2010 Cynthia J. Koelker, M.D. |
| doctors don't want to miss something - we may be | | | | |