Why Does Healthcare Cost So Much?

August 10, 2010
David Lubin, MD

In an LA Times column, Stella Fitzgibbons, MD, blamed the rising cost of healthcare on expensive in-hospital workups. I can't really argue with that.

In a recent column in the LA Times, Houston internist, Stella Fitzgibbons, MD, explained why there has been a tremendous increase in the cost of healthcare. She blamed it on patients taken to the hospital for evaluation. She cites two cases, one an end-of-life scenario, costing tens of thousands of dollars, and another of a minor problem, which could have been treated as an outpatient, but would have cost thousands more if the patient were admitted. I can’t really argue against her case. I’ve recently had two of my own.

One 60-something-year-old male patient went to the ER after he nearly passed out because his blood sugar was in the 60s. Rather than just giving him glucose and sending him home, the doctors in the ER ordered thousands of dollars worth of tests before concluding that his sugar was low and sending him home.

Another male patient, 42 years old, told, me last week that he thought he had eaten some bad fish, had an episode of vomiting at home, then felt weak, passed out, and hit his chin on the floor, requiring a trip to the ER and six stitches. But in overlooking the obvious, the ER physician proceeded with another multi-thousand-dollar workup.

Each workup was conducted to make sure the patient didn’t have a silent heart attack. I spoke with the head of the ER at the hospital in the first case. He explained that, in the past, the hospital was burned when a patient was admitted with what seemed to be a gastrointestinal problem, and later died of a heart attack on the floor. After that, the hospital instituted a cardiac workup, similar to what my patient in the second case had.

The workup consisted of extensive lab work that included a complete blood count; chemistry profile; CPK to check for heart muscle damage; Tropinins (another test to check for a heart attack); a D-Dimer, which is elevated in deep venous clots and pulmonary emboli, and for some reason was elevated in this patient; an NT proBNP, a test that is elevated in congestive heart failure (and, of course, was normal); a Protime and PTT, tests to determine clotting times; and lastly a blood alcohol test, of which NONE was detected. In addition, he had a chest x-ray and CAT scan of the head, both of which were normal.

What scares me is that the whole panel was probably ordered when the patient hit the emergency room and before the ER physician evaluated him. They wanted to admit my patient overnight, but he refused. He had been sutured, was feeling fine, and went home. Can’t say I blame him.

Cases like this demonstrate why the cost of healthcare is so high. Neither of these patients would have had such an extensive workup had they gone to a primary care office rather than the ER. The ER was practicing defensive medicine to avoid a potential lawsuit had they missed a more serious diagnosis. We must have tort reform to keep down healthcare costs.