Always a source of amusement, KevinMD, recently wrote one of his commentaries on why doctors are increasingly ordering more and more tests. He basically says that because of the easy access to medical technology (i.e. CTs, MRIs) and the fact that young doctors have grown up and learned with said technology, they have come to rely on it for diagnosis rather than on physical exam.
He sites an article in Time.com, written by a couple of doctors in which they state:
"Another reason for overtesting is simply that new doctors can't function without them. Lately, radiology tests have become a crutch: doctors in training are no longer taught how to distinguish patients who need testing from those who don't."
Another juicy quote from the same article: "There is actually a more subtle positive incentive: ordering a test — cost aside — takes less effort than spending the time to think about whether it's really needed."
Here is my thought: If so little critical thought goes into what could really be going on with the patient, and care is based on a symptom that triggers a certain test, why do we need doctors anymore? Surely someone who makes a lot less money, or a computer, could make decisions about ordering tests. An algorithm could be made in which symptoms are presented to a cheaper employee or computer, and a set of tests are ordered. Based on the results of those tests a diagnosis is made. Makes sense to me. Are doctors becoming obselete?
And yet, mid-level providers- mainly NPs are not looked upon highly by many doctors. PAs get more respect- likely because they have "physician" in their title.
ReplyDeleteWe have a few NPs at the nursing homes or clinics that send pts to the ED and our docs often make rude comments about them "thinking too much". Gee, lots of times they diagnose the patient without all the spendy tests...
I too am tired of every single patient getting a scan. Or scanned everytime they come in, which if it is more than once it is likely too much.
You know what - I actually think in certain cases, we are obsolete. Certain situations (at least in the ER) really don't need much thought - like perhaps an ankle sprain or mild rectal bleeding in a stable young healthy person.
ReplyDeleteHowever, not everyone needs every test and some need every test there is. An algorhythm could be made to get some of it right but someone would have to take a history and the computer would have to develop that "sixth sense" when they clinically evaluate someone.
That said, having a machine that just order tests is a lot more expensive than paying someone - but I agree that some MD's may as well be replaced since they seem to lack any clinical acumen.
And by the way, NP's and PA's fall prey to this disease as well - not just young MD's.
Yup. It really comes down to laziness a lot of the times, and it's very sad because an MD with good assessment skills really can save lives. I've witnessed it before, actually with the ER doc that writes serenity now. He found an aortic dissection in a patient of mine that presented like a typical chest pain because he actually listened to heart sounds heard a new murmur. I shudder to think about what would have happened to the guy if he had been seen by any number of the other doctors I work with who will assess a patient from the doorway. He very likely would have ended up a chest pain observation and coded on our tele floor.
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