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Majority of Tests on ER and Inpatients Never Followed Up

From David E. Williams, writing in MedCity News:
"As discussed recently (in an article about med mal reform) I don’t buy the idea that excessive testing is mainly attributable to ’defensive medicine,’ i.e., doctors doing too much for fear of frivolous lawsuits. Rather, there are other reasons for ordering unneeded tests, such as profit motive on the part of the doctor or hospital, a desire for more information for decision making, habit, lack of familiarity with low-tech techniques, patient preference, and diagnostic company sales efforts. If med mal reform happened tomorrow, I’d be willing to bet plenty of excessive testing would still occur and that some other excuse would be given to explain it. Only payment reform, provider education and changes in patient demand are likely to make a big difference."
Williams is referring to this article from FierceHealthcare reporting on a recent Australian study finding that up to 61 percent of inpatient test results and 75 percent of tests on ER patients saw no follow up after discharge.  With subtle understatement, the study's authors conclude the "(f)ailure to follow up test results for hospital patients is a substantial problem."  Ya think?

Personally, I agree with Williams' conclusion that over-testing has many causes, with fear of lawsuits  way down the list.  Otherwise, why order extra tests and not follow up?  Legally, you're probably better off not ordering the test in the first place.

I support tort reform but more out of a general antipathy toward the trial lawyers among us, not out of any strong belief that it will cause a downward bend in the health care cost curve.

More: Link to the BMJ Quality & Safety article.

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