Trial and Error

Over-testing is one of the big stories in healthcare right now. David Lubin, MD, wonders when the screenings and over-testing became "the standard of care."

It was a late day at the office last Friday. It was past 5:00pm and the air conditioner in the building had shut off. The timer wasn’t working right, as it usually goes off at 6:00, but it really didn’t matter since we were to go on Daylight Savings Time Sunday. I was reviewing the last chart, records from another physician, and the cleaning crew was there. I left after 6:00 and when I turned the radio on in the car, I heard, “If you’ve been injured in an accident where someone has been texting or driving while distracted, call........”

We’ve got trial attorneys up the wazoo advertising here in Florida for plaintiffs to sue just about anyone. After the Bernie Madoff thing hit, there was a billboard in Tampa seeking those who thought their brokers might have financially ruined them. The Florida legislature will pass some sort of bill directed at “distracted” drivers, but right now, it looks as if texting while driving will be a secondary offense, where someone has to be pulled over for something else and THEN cited for texting. Hopefully that will change. Penalties should be severe for those texting, using their cell phones, or eating a burger and fries and driving simultaneously.

I read Dr. Kevin’s blog, referring to a blog by Associated Press writer Lindsey Tanner. She thinks we test too much. The various media have reported about screening mammograms, PSAs, colonoscopy, and the overuse of MRI scans. But for whatever reason, the screenings and over-testing soon become “the standard of care.” Now we all have patients who have missed their screening tests for one reason or another. The 75-year-old who has blood in his stool, turns up with colon cancer, and never had colonoscopy. Or the woman who had a normal mammogram, and two years later has breast cancer.

Do we feel guilty for having missed those? Is it our fault if our patients fall through the cracks and miss routine screenings and turn out later to have cancer; if they’re self-pay and can’t afford it, or they have a high deductible and don’t want to pay for it?

Are we going to get into our cars one day and hear, “If your doctor forgot to order your yearly PSA, mammogram, occult stool test, or you’re over 50 and haven’t had a colonoscopy, call.......”?