Skip to main content

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.

Labels:

Comments

Post a Comment

Popular posts from this blog

Michael Porter On Health Care Reform

Michael Porter, writing in the New England Journal of Medicine, proposes "A Strategy For Health Care Reform - Toward A Value-Based System." His proposals are fundamental, lucid and right-on, meaning they're sure to be opposed by some parties to the debate, the so-called "Yes, but..." crowd. Most important, in my opinion, is this: "... electronic medical records will enable value improvement, but only if they support integrated care and outcome measurement. Simply automating current delivery practices will be a hugely expensive exercise in futility. Among our highest near-term priorities is to finalize and then continuously update health information technology (HIT) standards that include precise data definitions (for diagnoses and treatments, for example), an architecture for aggregating data for each patient over time and across providers, and protocols for seamless communication among systems. "Finally, consumers must become much mor...
Post a Comment
Read more

Being Disrupted Ain't Fun. Deal With It.

Articles about disrupting healthcare, particularly those analogizing, say, Tesla's example with healthcare's current state, are frequently met with a chorus of (paraphrasing here) "Irrelevant! Cars are easy, healthcare is hard." You know, patients and doctors as examples of "information asymmetry" and all that. Well, let me ask you this: assuming you drive a car with a traditional internal combustion engine, how much do you know about the metallurgy in your car's engine block? I'll bet the answer is: virtually nothing. In fact it's probably less than you know about your own body's GI tract. Yet somehow, every day, us (allegedly) ignorant people buy and drive cars without help from a cadre of experts. Most of us do so and live happily ever after (at least until the warranty expires. Warranties...another thing healthcare could learn from Tesla.) Now, us free range dummies - impatient with information asymmetry - are storming healthcare...
Post a Comment
Read more

"An Affordable Fix For Modernizing Medical Records"

...from the Veterans Health Administration and Midland (TX) Memorial Hospital. I know enough about my own strengths and weaknesses to know that I'm no IT expert. But I am acutely interested in examples of people and teams thinking differently to solve long-standing, intractable problems and, for better or worse, there are lots of those to be found in the IT realm. Yesterday, it was a story about a team adding iPhone portability to MEDITECH functionality, delivering to harried physicians better access to clinical data and more productive hours in every work day. (Wow. Apple in the boardroom AND the physician lounge. Has to be an IT traditionalist's worst nightmare. But I digress...) Today, the Wall Street Journal features a story about Midland (TX) Memorial Hospital finding an affordable, open-source alternative to proprietary EMR systems : "In the push to digitize America's hospitals, Midland Memorial faced an all-too-common dilemma: a crying need for information ...
3 comments
Read more