Biggest factor in rising health costs are the doctors themselves

STEVE COLE
There are myriad factors involved in the rising costs of delivering quality care to the population, but the primary factor is with the health care providers themselves.
One of the reasons costs have continued to rise is that physicians and other health care providers are ordering more tests, prescribing more medications and requesting more consultations with specialists. The consultants will then order more tests, prescribe different medications and often request additional assistance from other consultants.
This vicious cycle is compounded by the fact that many of these tests and prescribed medications lead to complications (surgical complications, adverse effects from medications, etc.) that also contribute to rising costs.
Why do we order so many tests? The simple answers are that we "don't want to miss anything" and "because we can." We don't want to miss anything because it would mean that our 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. Because we have this desire to help by doing, we frequently do our patients a disservice.
Physicians are accustomed to performing well and answering correctly, as these are the traits necessary to become a physician in the first place. Many feel that if they surround themselves with more data, they will be able to arrive at the correct diagnosis. The problem inherent with this line of reasoning is that the solution to the problem is often buried in a massive, meaningless mesh of data, making it more difficult to arrive at the appropriate conclusion. We as a profession should strive for better data, not just more of it.
The third, often lamented, reason we "don't want to miss anything" is because of an intense fear of litigation. 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. It is an unfortunate truth that the phrase "first do no harm" has taken new meaning when finished by "...to your attorney's case."
The final reason we don't want to miss anything has to do with the way we educate new physicians. Prior to the advent of easily obtainable diagnostic tests, physicians primarily used the now ancient art of history and physical examination, whereas today's generation of newly trained physicians (my generation, incidentally) relies more heavily upon the laboratory result as opposed to listening to what the patient has to say. This shotgun approach to ordering a multitude of diagnostic testing has become reflexive in our training institutions and has changed the way physicians practice medicine.
The second part of the initial response to the question of why we order so many tests is much more troubling – "because we can." We can order all of these 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. Requesting consultations can positively affect the physician's business as well. 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.
To be fair, there are often times when these consultations are not only appropriate, but are necessary as part of a balanced plan of care.
All of the above mentioned problems lead to unnecessary testing, patient angst and a decreased quality of care. 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.
The overwhelming majority of physicians want to do the best thing for their patients, but not all of them have been taught the best way to do that.
As such, we should change the way we educate physicians and decrease the amount of financial exposure to litigation that physicians face.
I don't know the best way to remedy these problems, but as a physician, I have become a part of the problem and I know we can do better.
Dr. Steve Cole is a staff physician at Baylor University Medical Center, and works as an allergist/immunologist at Park Lane Allergy and Asthma Center in Dallas. E-mail him at SteveCo@ BaylorHealth.edu