In a physician chat group recently, a doctor who treats hospitalized patients made a recommendation to our group of 38,000 members that left me startled and alarmed. She shared her protocol for all COVID-19 patients admitted to the hospital: every one of them gets not only a chest x-ray but an entire battery of special tests, including a coagulation test, a leg ultrasound and a CT scan.
This was offered as her blanket standard of care. What it actually represents to me is one of the biggest problems with health care in America—because not every admitted patient needs all these tests. And this is not a new story.
Simply put, as physicians in the U.S., we overdiagnose and overtreat people. We order way too many tests, treatments and surgeries that you don’t need and that may actually harm you—and they cost money, lots of it. Incredibly, in a nation of 328 million people, we order approximately 15 million nuclear imaging studies, 100 million MRIs and CT scans and close to 10 billion blood tests on patients every year.
We’re not talking about a little pinch of “err on the side of caution” here. We are talking about runaway medicine, with patients aboard a system with no brakes, few guardrails and no one fully at the controls. Moreover, we as physicians don’t do a good job informing you of the downstream risk of these costly procedures, because we may not even recognize the mess we are creating in the first place.
Why all the tests? Well, we may order them because we are worried about missing a diagnosis and we want to get you healthy as soon as possible. Sometimes, it is to avoid getting sued. (When in doubt, it’s always easier to test.) Sometimes it’s because patients request the tests and we yield. Less innocently, we may order more tests because they bring in more money. We are doctors, but we are revenue generators too, and, for some, not necessarily in that order.
Let me walk you through two overdiagnosis/testing hypotheticals. Here’s one: You are admitted to the hospital with a cough and a low-grade fever. You test positive for COVID-19, and a chest x-ray demonstrates that you have a pneumonia. This is a fairly typical scenario. As a clinician, though, I also opt for a CT scan to make sure you do not have a blood clot in the lung (a pulmonary embolism), even though when you were admitted most doctors already would have put you on a prophylactic lower dose of a blood-thinner for this—to help prevent clotting.