NCPA - National Center for Policy Analysis


December 18, 2007

One of the biggest factor in rising health costs are the doctors themselves, says Steve Cole, staff physician at Baylor University Medical Center.

One reason is the rise in tests ordered by physicians:

  • Doctors don't want to miss anything because it would mean that patients may unnecessarily suffer from an illness by our inability to quickly diagnose the problem.
  • The vast majority of physicians feel the need to help their patients by doing -- and ordering more tests fulfills the physician's needs but is not what is necessarily best for the patient.

Another reason for all of the tests is an intense fear of litigation, says Cole:

  • The medical student is frequently reminded by mentors of the likelihood for lawsuits brought about by a missed diagnosis.
  • As a consequence, the practicing physician has a tendency to practice defensive medicine, ordering as many tests and requesting a multitude of additional consultations in an attempt to stave off potential legal action.

Many order tests because there is no cost to the ordering physician; in fact, there is often a financial incentive to do so:

  • The physician is awarded a higher level of complexity when reimbursed if he or she prescribes medications, orders diagnostic testing or requests a consultation with another physician.
  • By sending patients to multiple physicians in various specialties, the physician becomes a part of a referral circle, a kind of network that ultimately leads to more patients walking through the door of each physician involved.

All of the above mentioned problems lead to unnecessary testing, patient angst and a decreased quality of care, says Cole.  We should take into account the degree of complexity in reducing or discontinuing a medication and reward those physicians with the courage and common sense to do so.

Source: Steve Cole, "Steve Cole: Biggest factor in rising health costs are the doctors themselves," Dallas Morning News, December 17, 2007.


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