Tuesday, July 29, 2014

Dr. Orthochick: Unnecessary tests

Me: I don't think we need to order an MRI. He probably has a meniscus tear, but he has so much other stuff going on that it's not like we're going to do anything about it.

Dr. Douche: What are the drawbacks to getting an MRI?

Me: Cost

Dr. Douche: Are you paying for his MRI?

Me: Not directly...

Dr. Douche: Does he have to pay for his MRI?

Me: Uh, I think so.

Dr. Douche: No, it's covered in the copay. So the only person who has to pay for this is the taxpayers. So there are no drawbacks associated to getting an MRI. Order an MRI.

...and that's why healthcare costs are so high. Because there's no downside to ordering expensive and unnecessary tests.


  1. I'm being taught in (basic sciences portion of) med school "never order a test if the outcome is not going to change what you do" ... Why do I have the sneaking suspicion this lesson will be wiped away as soon as I enter clinicals? (We were also taught by a very fancy hematologist not to do transfusions based on numbers, but to follow clinical signs/symptoms because head to head comparisons of people who do and don't get transfusions (based on numbers, not clinical indications) favor NOT giving them. ... This is going to be another lesson to be unlearned, I suspect.

    1. Depends on how lucrative the specialty. Surgeons basically get to throw the EBM book out the window. Medicine people tend to follow it more closely.

    2. ^@Anon5:50 - Ah, so that's why the cardiologists who are good 'medicine people' just cath everything that walks through the door - it's not lucrative at all and strongly evidence based.

      And to Anon2:09 - funny, because that's what my chief surgical resident (who's not a fancy hematologist) and I were just agreeing with today, as we discussed the results of the TRICC and TRACC trials in relation to a patient of ours. Yeah, treat the patient not the number. You shouldn't unlearn that lesson. (Unless you're on a medicine service and that calcium is 2.19mmol/L....you'll be treating ;-P) And, no, you really should not order a test unless you're using the results for management; we joke about 'therapeutic CT' but it's not a real thing. That really is the majority of medicine and surgery, despite the outliers that as Orthochick's post demonstrates do exist.

  2. Dr. D's mentality is one reason why public respect for doctors has declined. It also likely led to the insurance companies' current policies that lead to automatic denial of many tests. So a few docs make it harder for patients to obtain good care and make life more difficult for docs who try to use good clinical judgment by ordering tests only when they will change management, as Anon noted above.

  3. This mentality drive s me crazy!!

  4. I see it all the time. People who want an MRI that won't change anything because their insurance (and, by extension, other people) will pay for it.

  5. What does he mean "it's covered in the copay"? The copay is the portion the patient pays! Furthermore, did Dr. Douche look up the patient's benefits and verify that the patient has met his deductible and out-of-pocket and that the insurance will pay everything at 100% now? No? Then what if the patient has a $10,000 OOP?

    His taxpayer comment makes it sound like they were dealing with a Medicaid patient, but that doesn't absolve him of his wastefulness. No drawbacks my meniscus!

  6. Hey, any chance of Dr Orthochick branching out and getting her own blog? She's the only reason I read this blog since I don't particularly enjoy most of Fizzys stuff.