More About Ancillaries
From the comments to "Ancillary My Ass":
I am wondering how ordering these useless tests is different from stealing? Doctors who do these tests think they really need to supplement their income because the insurance companies don't pay enough. Well, the company I work for doesn't pay me enough either. If I had only one 4% raise in the last 2 years - and this is with pretty good evaluation, does it mean I can take somebody's money by convincing them they need to buy something from me that they really don't need just so I can get my income in line with the inflation? And there is a difference between selling people something they don't need and ordering a test: at least with the former nobody believes his/her life will be in danger if they refuse.How is this different from stealing, eh?
Why, I don't think it is at all!
As for other commenters who pointed out the standard defensive medicine, CYA and "but he found all kinds of things" answers, I still say BULLSHIT.
Medical diagnosis consists of (in order!):
One scenario that annoyed the hell out of me was a patient assigned to my HMO panel who called and said that he needed a referral for an MRI of his brain. WTF? It turned out he had had what sounded like a TIA and a neighbor -- who was a retired chief of radiology at a large tertiary care center -- told him he needed to see his friend, the neurologist: chief of neurology at said tertiary care center. When he called for the appointment, he was told he needed to have an MRI before being seen. I eventually managed to get the guy to come in to my office, went through the appropriate workup, got him started on aspirin and controlled his blood pressure, all without an MRI or a referral to the chief of neurology at a big tertiary care center, who had much better things to do with his time than take care of an uncomplicated TIA.
I understand that in today's busy world of medical practice it is considered efficient to have as much as possible completed before seeing a patient. I have no problem with things like vital signs being completed before walking into an exam room. But however you slice it, PFTs are not "vital signs."
Defensive medicine is real, without a doubt. But routine PFTs literally on everyone who walks in the door is not defensive; it's indefensible. As for detecting clinically significant occult conditions on testing before they become apparent either to the patient (in the form of symptoms) or to an astute clinician on physical exam, it doesn't happen nearly as often as often as you might think.
So what's the difference between ordering unnecessary tests and stealing?