Choose Wisely: Do You Really Need to Order That Test? Part 1

After the New York Times published an article calling into question the necessity of the annual physical, it seems publicity surrounding routine medical testing has flourished.  Individuals and healthcare providers are calling into question the need for routine EKG's, pap smears and colonoscopies.  Most have mixed feelings about this issue.

For healthcare providers, fewer annual physicals means fewer office visits, ordering fewer tests and therefore earning less money.  Sure, it is unethical to order tests patients don't really need, but can all providers be trusted to practice ethically when lost revenue may be the end result?  Physician groups such as the American Academy of Family Physicians and the American College of Cardiology are responsible for creating guidelines for treatment of patients.  Given their physician influence, will they keep the best interest of the patient in mind or the best interest of the providers?

For individuals, concepts such as the annual physical and the yearly pap smear are ingrained into patient's thinking as a necessity and an important step to health prevention and maintenance.  Are patients comfortable forgoing a routine EKG to save money or would we rather have the peace of mind knowing their heart "looks OK".

The bottom-line of this issue is cost.  Medical tests are costly.  With routine testing, as a medical provider you will have many incidental findings.  An EKG on a young patient without cardiac symptoms may lead you to order an echocardiogram or a stress test  which reveals a normal heart and was therefore unnecessary.  These tests may have cost your patient thousands of dollars.  On the larger economic scale, these tests resulted in higher insurance premiums for your patient's company, missed days of work and therefore a decrease in productivity.  Multiply this by millions of people and suddenly routine medical testing has a huge and unnecessary economic impact.

Are you as a nurse practitioner comfortable reducing the number of routine medical tests you order?  Do you feel responsible for helping to reduce the cost of healthcare for your patients and our country?  Here are my suggestions.  First, be open to change.  Routine medical testing schedules and recommendations are likely ingrained into your practice.  Begin to question them.  Educate yourself and your patients about the issue at hand.  Be aware of what routine medical tests cost so you can help your patients make informed decisions about their medical care.  My opinion: Ultimately, if you collaborate with your patients regarding their medical care rather than follow a strict, regimented testing schedule you will have higher patient satisfaction compared to other providers.  Satisfied patients lead to a busier practice which will offset any loss in revenue your practice might experience.