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4 ways for doctors to avoid inappropriate medical tests

Defining the problem“If a test doesn’t influence decisions, it’s a waste.”

- Jodi Segal, BS, MD, MPH, Johns Hopkins

• The healthcare system spends $750 billion a year in avoidable costs

• Inappropriate use of testing can deny the timely resolution of an accurate diagnosis

• Inappropriate testing causes real harm to patients who need care

Igelhart NEJM 2009. Vol 360 p1030

The rising cost of diagnosis

Imaging and diagnostics costs are the front-runners in the rising cost of healthcare

98,000 deaths per year due to medical errors

50,000

40,000

30,000

20,000

10,000

0

Corrigan J, Kohn L, Donaldson M Eds, To err is human, Institute of Medicine 1999.

According to a recent study, between 44,000-98,000 people in the US die from “medical errors” each year. Even using the lowest estimate, this place medical errors as the 8th leading cause of death (Corrigan J, Kohn L, Donaldson M Eds, to err is human, Institute of Medicine 1999.)

Patient Requests:

Patients often view medical testing as proof that their physician is giving them a more thorough level of care

Drivers of Inappropriate Testing

Time:

Doctors often find it quicker to order a battery of tests than to talk to a patient or pore over a case

Ask the patient: do you want this test? When you empower the patient, they make intelligent decisions

- Adam Finkelstein, MD, Swedish Covenant

Income:

It shouldn’t be assumed that doctors would order an unnecessary test purely for monetary gain, but the extra income is probably appreciated, and not all are enthusiastic to part with it

Drivers of Inappropriate Testing

Liability:

A litigious patient is a scary prospect for a doctor, and a thick paper trail of tests makes many feel they have insured themselves

“Testing needs a rational, deliberate strategy. Before you order a test, you should know what you will do with the results.”

- Mimi Kokoska, MD, MHCM, FACS, CPE, Indianapolis VA Medical Center

Biggest problem: The system

The US boasts a medical community which can supply the latest in tests and technology, but perhaps access to a litany of tests has made their ordering rote, diluting pinpoint diagnostic accuracy.

“When you build lots of screenings into the system, you get just what you asked for: lots of screening, regardless of whether it’s useful.”

- Brian Jackson, MD, MS, ARUP Labs

Educate:Work with students and others around you to create an ethos of purposeful testing

Solution #1

Solution #2

Advocate:Ask hospital administrators and leadership to take steps towards fostering a diagnostic testing culture change

Solution #3

Engage:Encourage your patients to become a partner in their health by cultivating collaboration and treatment decision support

Solution #4

Ask:Build a standard of collaboration amongst colleagues and peer specialists by asking them when you’re not sure about a test. Don’t be afraid to say, “I don’t know.”

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