Many Doctors, Many Tests, No Rhyme or Reason

[groovedaddy]

I recently took care of a 50-year-old man who had been admitted to the hospital short of breath. During his monthlong stay he was seen by a hematologist, an endocrinologist, a kidney specialist, a podiatrist, two cardiologists, a cardiac electrophysiologist, an infectious-diseases specialist, a pulmonologist, an ear-nose-throat specialist, a urologist, a gastroenterologist, a neurologist, a nutritionist, a general surgeon, a thoracic surgeon and a pain specialist.

He underwent 12 procedures, including cardiac catheterization, a pacemaker implant and a bone-marrow biopsy (to work-up chronic anemia).

Despite this wearying schedule, he maintained an upbeat manner, walking the corridors daily with assistance to chat with nurses and physician assistants. When he was discharged, follow-up visits were scheduled for him with seven specialists.

This man’s case, in which expert consultations sprouted with little rhyme, reason or coordination, reinforced a lesson I have learned many times since entering practice: In our health care system, where doctors are paid piecework for their services, if you have a slew of physicians and a willing patient, almost any sort of terrible excess can occur.

http://www.nytimes.com/2008/03/11/health/views/11essa.html?th&emc=th

[Dave_Fl_50]

1. Like House said. Pick your specialist, pick your diagnosis

[Warpy]

2. OK, this says it all

“When I started in practice, I wanted to do the right thing,” he told me matter-of-factly. “A young woman would come in with palpitations. I’d tell her she was fine. But then I realized that she’d just go down the street to another physician and he’d order all the tests anyway: echocardiogram, stress test, Holter monitor — stuff she didn’t really need. Then she’d go around and tell her friends what a great doctor — a thorough doctor — the other cardiologist was.
---

Hey, STOOPID, that young woman probably was presenting with a REAL PROBLEM that YOU blew off as ANXIETY!!! That second cardiologist SAVED HER LIFE, asshole, by hooking her up to that Holter monitor for 24 hours to see what her heart was really doing instead of patting her on the head and feeding her Valium, like YOU DID. She knew something wasn't right and it wasn't all in her pretty little head, fuckwit, the problem is in YOURS.

The arrogance of these halfwits is astonishing. A 50 year old man who can only walk with assistance, who's chronically short of breath and chronically anemic needs to find out why he can't walk or breathe and where he's losing all that blood. 50 is far too young to be in that kind of lousy shape.

He got all that shit because he needed all that shit and trust me, they fought some insurance bean counter every step of the way to get it.

[hedgehog]

4. And of course, the doctor has to have all the equipment in his own

office, so he has to order the tests in order to pay for the equipmnet. What's wrong with sending the patients to a free-standing testing center as needed?

[Warpy]

6. Few docs perform stress tests in the office

and imaging services are also done by hospitals on outpatients. The Holter monitor is different and anyone who presents with complaints of palpitations no matter the gender or age needs to be checked out instead of given a Valium.

Women are consistently blown off by male cardiologists and the consequences can be fatal. This is what I addressed in my post.

[hedgehog]

7. I should have made clear that the original article was describing

the "plight" of the specialist forced to buy and use all the fancy equipment.

[Warpy]

8. The only guy I knew who did that

ran a big clinic in a medically underserved part of Florida. He had everything at that clinic for every body system you can imagine.

They eventually built a hospital in the area. He's cheaper.

[Mojorabbit]

3. I have an issue with the article

while there ARE some abuses there isn't a doctor in the world who isn't going to treat an abnormality that shows up in a test on a hospitalized patient. It would be a risk of an instant lawsuit.

He also says that imaging tests have increased on medicare patients yet these are mostly elderly and are going to have the most going wrong physically. It is easy to say don't do the tests but then again if they aren't done and it is you and then it is to late to fix what is wrong I imagine a person would be pretty upset.

As for the patient he cites.
"He underwent 12 procedures, including cardiac catheterization, a pacemaker implant and a bone-marrow biopsy (to work-up chronic anemia). "

Obviously he had a cardiac problem since a pacemaker ended up being implanted. And if he was diagnosed with anemia then one would want to check for leukemia. (This happened to my dad and he ended up with leukemia).

As technology advances this will be more of a problem. I don't know what the answer is.

[hedgehog]

5. The real question here is this; was there a single person in charge

who was guiding these tests? If so, what's the problem? I imagine that 80% of the cases a doctor sees are straightforward no-brainers. It follows then that the other 20% would take up 80% of the testing procedures because the diagnoses are tricky.

[supernova]

9. What's sad is that this

hairbrained article actually got published in the NYT.

:eyes:

The writer, a card no less, doesn't even say what the dx or suspected dx was. Who was the attending on duty? He's just generally dismissive of all of it because the patient somehow didn't magically need it in his NSHO. Was the writer even involved with the case or was he just a tangential observer? Maybe he did and maybe he didn't need all those tests and consults, but you certainly couldn't tell from the sloppy thinking in that article.