Real input from real practitioners in the industry in the real world.
Sure, Malpractice overhead exists but it's analogous to a drop in the ocean. There is severe waste elsewhere that need to be handled first.
It's a nosebleed in a patient hemorrhaging blood through a punctured artery.
The argument that ordering extra tests offer doctors "additional defense" in case of a lawsuit is absolute hogwash. If anything, the test results put the doctor at a further disadvanatge wrt defense because they had an additional datapoint they should have considered in their diagnoisis but did not.
The primary issue with Healthcare in the U.S. is cost - for those who have the money and the will to spend it, it's one of the best in the world. A lot of the rich visit the US for their Healthcare needs.
This is very wrong as it encourages short term profit seeking behavior which is absolutely the opposite of what healthcare should be (eg: C Sections being preferred over natural but long childbirth)
A for-profit system does not help the doctor/provider either (although it gives an illusion of it) - in such a system, the patient's only recourse is to sue the doctor/provider for damages instead of both parties focusing on the root cause which brought the patient to the doctor/provider in the first place.
Extra Medical Tests might be suboptimal but the real pain points are the marginal costs of each test.
Tests in the U.S. are extremely expensive. There is no standardized pricing for any test in the U.S. unlike the rest of the world.
While the rest of the world has pretty much agreed, for example, that a blood group test might be no more than $10 (In India, it costs 20 cents upto 70 cents at current INR-USD exchange rates), in the U.S. depending on which lab you go to, your insurance coverage, your ability to pay and other factors, you might be billed anywhere from $0 - $2000.
That is completely insane.
Also, labs in the U.S are not setup to take requests from customers directly. There are kits you can order and all that
Everytime I try to send a blood sample to a lab on my own, the lab staff seem to be lost - they want my insurance information, my EHR information, my NPI ID and when I explain to them I am not a doctor they ask me to provide my physcian's who ordered the test. (my physcian didn't order the test - I did).
I have had a few labs bill me outrageous out of network fees because the lab tests were not ordered by an in network provider (because I ordered them and I am not a doctor) and the amount of calls and paperpushing I had to do to correct the billing has made me just give up and let a doctors office handle this.
I can read a lipid panel. I don't need to go to a doctor's office to drive in traffic, wait an hour or more just to draw my blood and have it sent to a lab and then have the doctor read the panel to me. I read spreadsheets every hour of the day. I know what mean median and mode is and the lab result often offer these values anyways as part of the report.
I just need the test report.
Now, if my HDLs are too high and I cannot figure out why, sure, I do need to discuss this with a professional.
The solution to this madness?
An "all payer rate set" system. EVERYONE pays the same for the same procedure. Who pays for the care, while important, comes later, not before.
> Excess tests result in a higher number of false positives
True, but this is an engineering problem:
1. Just because some tests have a higher number of false positives does not mean all tests have a higher number of false positives
2. For those tests that do have a higher number of false positives, the well educated (and paid) professionals are aware and should have measures in place
Eg: Bloom filters are fantastic datastructures to test membership. However, they have false positives. We can control the probability of getting a false positive by controlling the size of the Bloom filter.
> Just because some tests have a higher number of false positives does not mean all tests have a higher number of false positives
No, but doing more tests leads to more false positives, which can lead to disastrous consequences. For example, someone could think they have aids through a false positive and lose their family, or choose to make an abortion, or start consuming preventive dangerous drugs, etc.
Not only that, you can bankrupt someone. It would surprise many how medicine is practiced differently based on available costs!
> For those tests that do have a higher number of false positives, the well educated (and paid) professionals are aware and should have measures in place
Yes, the measure is not to do them unless the symptoms and the DDX fit, along with other criteria.
"1. Just because some tests have a higher number of false positives does not mean all tests have a higher number of false positives"
No - this is a math problem. As you do tests on low prevalence populations (inherently what you're doing when you say 'excess tests'), positive predictive value drops. Sure, it will drop more for worse tests, but this is a trait of all tests.
"2. For those tests that do have a higher number of false positives, the well educated (and paid) professionals are aware and should have measures in place"
One of the problems is distinguishing between "This thing is here" and "This is a clinical problem". For example, if I give you the (highly sensitive) PCR test for C. difficile, you may very well have C. difficile in your guts. But that doesn't mean that's what's making you sick.
Similarly, there are a number of cancer screening tests that will detect cancers that will kill you decades after something else does - including, potentially, the surgery to deal with said finding.
False positives. My wife underwent multiple tests including a nuclear one to learn that her kidneys aren't exactly the normal shape. Completely harmless.
However, you do have something of a point. The normal screening tests should be able to be ordered by an insurance company or by the patient themselves. If you don't have any other medical issues that need a doctor there's no reason for a visit unless the tests find an abnormality.
The primary issue here is the resulting cost.
As the article points out: "about 26 percent of every dollar spent."
You probably won't complain paying 26 cents for a $1 popsicle, but if the same popsicle cost you $100, you might be upset paying $26.
But is not the bigger question: Why is the popsicle $100 when it could have cost $1?
Here is a useful chart to show where the money goes: https://qph.fs.quoracdn.net/main-qimg-d68aea3ca1e466f166752e...
Where do you think malpractice costs fit there?
I personally feel sad everytime malpractice fears enter the discussion of costs - its a tiny, ignorable portion right now of total expenses.
However, to a typical layperson, it sounds like a big deal to worry about but actually distracts the attention costs should be getting.
As a result, I have tried to cover it here: https://www.quora.com/Why-does-one-believe-that-malpractice-...
Real input from real practitioners in the industry in the real world.
Sure, Malpractice overhead exists but it's analogous to a drop in the ocean. There is severe waste elsewhere that need to be handled first.
It's a nosebleed in a patient hemorrhaging blood through a punctured artery.
The argument that ordering extra tests offer doctors "additional defense" in case of a lawsuit is absolute hogwash. If anything, the test results put the doctor at a further disadvanatge wrt defense because they had an additional datapoint they should have considered in their diagnoisis but did not.
The primary issue with Healthcare in the U.S. is cost - for those who have the money and the will to spend it, it's one of the best in the world. A lot of the rich visit the US for their Healthcare needs.
Healthcare in the U.S. is optimized for profit: https://www.quora.com/What-makes-the-US-healthcare-system-so...
This is very wrong as it encourages short term profit seeking behavior which is absolutely the opposite of what healthcare should be (eg: C Sections being preferred over natural but long childbirth)
A for-profit system does not help the doctor/provider either (although it gives an illusion of it) - in such a system, the patient's only recourse is to sue the doctor/provider for damages instead of both parties focusing on the root cause which brought the patient to the doctor/provider in the first place.
Extra Medical Tests might be suboptimal but the real pain points are the marginal costs of each test.
Tests in the U.S. are extremely expensive. There is no standardized pricing for any test in the U.S. unlike the rest of the world.
While the rest of the world has pretty much agreed, for example, that a blood group test might be no more than $10 (In India, it costs 20 cents upto 70 cents at current INR-USD exchange rates), in the U.S. depending on which lab you go to, your insurance coverage, your ability to pay and other factors, you might be billed anywhere from $0 - $2000.
That is completely insane.
Also, labs in the U.S are not setup to take requests from customers directly. There are kits you can order and all that
Everytime I try to send a blood sample to a lab on my own, the lab staff seem to be lost - they want my insurance information, my EHR information, my NPI ID and when I explain to them I am not a doctor they ask me to provide my physcian's who ordered the test. (my physcian didn't order the test - I did).
I have had a few labs bill me outrageous out of network fees because the lab tests were not ordered by an in network provider (because I ordered them and I am not a doctor) and the amount of calls and paperpushing I had to do to correct the billing has made me just give up and let a doctors office handle this.
I can read a lipid panel. I don't need to go to a doctor's office to drive in traffic, wait an hour or more just to draw my blood and have it sent to a lab and then have the doctor read the panel to me. I read spreadsheets every hour of the day. I know what mean median and mode is and the lab result often offer these values anyways as part of the report.
I just need the test report.
Now, if my HDLs are too high and I cannot figure out why, sure, I do need to discuss this with a professional.
The solution to this madness?
An "all payer rate set" system. EVERYONE pays the same for the same procedure. Who pays for the care, while important, comes later, not before.