So, I without really realizing it have become a crusader against stupid, wasteful, and unnecessary medical testing. I see it every day and I can’t help it. It just drives me nuts. So much of what we do as physicians is completely worthless or at least excessive. One can argue about defensive medicine – and yes, I agree that is a good part of it. Especially when it comes to ordering things that specifically rule stuff out that is dangerous or life threatening – like CT’s of the chest when a 50 year old guy presents with upper back pain to rule out dissection. But then there is everything else. Much of it I believe is done because we just want to investigate EVERYTHING. I mean, it may just be because we are intellectually curious – not just because we are worried about missing something really bad. We just want every little thing explained. This could entail ordering esoteric blood tests just to check for something really rare. Or calling a rhematology consult to see someone with chronic RA and new atypical symptoms. ENT consult for ear pain, etc.

There is a time and a place for this – usually it should be done over time as an outpatient. Especially if the symptoms are not likely anything really serious (like possible cancer, etc), there is no rush to investigate everything. No need to CT or MRI every little ache and pain. CERTAINLY this stuff should not be done as an in patient or in the ER. This time is reserved for dealing with serious, more acute issues. All the mental medical masturbation can wait until the patient is discharged. You don’t need an Echo, EEG, CT, MRI, and EMG just because the patient has some symptoms that might be answered by doing them – UNLESS missing it would seriously endanger the patient in the short term. Otherwise, just let the PMD deal with it the week after they go home.

I see this kind a crap all the time. I read what my colleagues have ordered and scratch my head. I see the workups people have gotten in the hospital – and for what? I am baffled by the stupid crap people order and the ridiculous consults people get. I get furious when my nurses order dumb garbage on a patient before I have gotten a chance to see them. I swear I spend half my shift d/c’ing orders that were ordered by the nurse. It doesn’t help though that many of my colleagues just go along with it – and even encourage it to speed things up. I would argue it often doesn’t! Once something have been ordered and can’t be cancelled, you have to wait for the result since you have to address it if it is abnormal – even if it has no bearing on what is acutely wrong with the patient.

It’s a huge waste of money. A huge waste of health care dollars. It sets up unrealistic expectations in patient who now demand every test all the time. We’re blowing through cash like there’s no tomorrow. We have to put some curbs on this kind of wanton wasteful behavior. I hate proposing restrictions on what we can do and what we can order – but it’s come to pass. We need to really explain WHY we are ordering something – because half the time I bet the answer is “well, I just want to know what is going on”.

Listen Douchebag, we underpaid peons really don’t need to hear that you “have officially cleared more than one million dollars in a year now that (you) have removed (your)self from all insurance plans!!”.
I’m glad for ya that you can overcharge insurance companies by more than 100 grand a case for routine spinal operations (which have been shown to have a fairly low success rate by the way) while I get excited if I get a few hundred bucks for successfully resuscitating someone back from the brink of death.
You rubbing it in just makes everyone hate you.

;

We are taught that “red flags” are things that when found in the history and physical of a patient’s assessment should alert you to sometime particularly serious going on. Rapid onset of sore throat with muffled voice is one for epiglottitis for example.

There are also red flags that I propose that show me that there is a very high degree of certainty that you are nuttier than a fruitcake.

1). You are lying there in your tight little blue striped Speedo underwear with dyed orange hair. Oh, and you are in your late 50′s and still live with your Mom who is sitting there next to you.

2). You open up the conversation with “Now Doctor, I normally have a VERY high tolerance for pain…”

3). You have your Ipad, Rolladex, and note pad and paper out and you flip through them and enter data continuously while I interview you.

4). You cry crocodile tears with every answer you give me.

5). You refuse to let your spouse (the patient) answer any questions him or herself – even though they are clearly capable of it.

6). You have an insane amount of horrible plastic surgery.

7). You have a psychiatric disease that is given a more “medical” sounding name in order for you to think you don’t need to see a psychiatrist.