There’s lots of political talk about saving healthcare dollars and cutting back on costs, yet everyday I see those dollars wasted.
Often, it’s the unnecessary consult. Sometimes, it’s the referring physician’s fault. Despite normal tests staring them in the face, they think it would be a good idea to get an expert’s opinion. Granted, that is often driven by the patient insisting that something must be wrong with them. If they are tired and can’t lose weight, it must be their thyroid. If they are having erectile dysfunction, their testosterone must be "too low for them" even though the results are in the normal range. Other times, it is because they have ordered a test that they don’t know how to interpret; tests that have no clinical relevance. I can’t count how many times I have had patients come to me because someone in their infinite wisdom checked their thyroid antibodies even though the thyroid hormone levels are normal.
Speaking of doing the wrong tests, I also see patients who have had tests and when I ask why, "I don’t know, I guess it was routine" or "I think my doctor was just being thorough" is the answer. Well, there’s thorough and there’s casting a big net to see what you catch. Why the vitamin B12 level? Why the insulin level? Sure, there are times they need to be checked, but I know of at least two doctors who just do it routinely. Why the nuclear thyroid scan? Because of hypothyroidism. Uh, but that’s not an indication for that test.
Then there are the meds and supplies that are prescribed, picked up, and then are infrequently or never used. Then they expire. For example, glucose test strips expire. So when I advise a patient to check his blood sugar three times a day, and he checks twice a week, and his mail-away pharmacy automatically refills it after 90 days, he is going to end up with test strips that expire. And they aren't cheap. I know patients with CPAP machines for sleep apnea they don’t use. How much was spent on that? Not to mention the cost of the consequences of not adhering to the treatment plan.
No, I don’t know how to fix it. I wish I did. Maybe if patients were held more accountable for their healthcare costs. I have a couple of patients who unfortunately have come upon hard times. They have either lost their insurance altogether, or they have a bare-bones policy that doesn’t cover much. One of them decided it was cheaper to diet, exercise, and lose weight than to keep taking so much medication. Wow. What an epiphany. I wish it didn’t have to be because she lost her job, but hey, she’s healthier now than when she was working.
There is another who asks which tests are the absolute necessary ones, and what is the minimum frequency at which they must be done. How often do we routinely get labs done quarterly even if they have been normal and nothing else has changed? Maybe some things still need to be quarterly, but maybe others can be once or twice a year if all else is stable.
We need to curtail costs somewhere. I think we can all agree on that. It’s a question of how. Do we start with patient education? Physician education? Tort reform? I don’t know. All I know is it disheartens me when I see healthcare dollars going down the toilet.