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I try hard not to duplicate tests. Unfortunately, in my experience, I’m in the minority.
When I started out, I ordered everything in the work-up for, say, neuropathy, at the first visit even if the patient said, "Dr. Smith just did some labs." I was impatient. I wanted to find out what was going on, so I just ordered a complete work-up. I didn’t want to wait a week or two to get the other doc’s results in, or go through the rigmarole of having the patient sign a release. In my younger days, I was in a hurry to figure the case out and didn’t care about money. So if a patient hadn’t brought his past stuff, I just did it all.
The longer you do this job, though, the more you realize how wasteful this is. Ordering labs costs the patient money, costs the insurance company money, and (by extension of increasing premiums) sooner or later costs me money. Plus, why put patients through painful procedures if you can avoid them? They appreciate that kind of thinking. I would, too.
So now, I wait. Most office cases aren’t urgent. I send a release when needed or call the referring physician for past test results. Usually, they show up in 1-2 weeks and I review them. Then, if things are missing, I write out a lab order to cover them and notify the patient.
I still run into younger docs who don’t do this, and just order everything right off the bat. Looking at it with the experience of 15 years in practice, that seems remarkably wasteful. Yes, occasionally you encounter results that should be repeated, but not often.
This is how it was taught in my residency, and still is today. Perhaps it’s an ivory tower view that the referring physician couldn’t possibly have ordered anything of value, or there’s an emphasis in training on quickly cracking the case, regardless of a lack of urgency.
It’s unfortunate that medical training, to a large extent, still doesn’t emphasize the financial realities of ordering duplicate tests. As we all try to provide better health care with fewer dollars, this kind of awareness becomes more important. I suppose it also could be seen as an argument for a centralized medical record system, so that we can all quickly see what’s been done, but I’ll leave that debate for another time.
The older I get, the easier it is to see these issues from the viewpoint of a patient. Who wants to waste money or blood on unnecessarily duplicated tests?
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
I try hard not to duplicate tests. Unfortunately, in my experience, I’m in the minority.
When I started out, I ordered everything in the work-up for, say, neuropathy, at the first visit even if the patient said, "Dr. Smith just did some labs." I was impatient. I wanted to find out what was going on, so I just ordered a complete work-up. I didn’t want to wait a week or two to get the other doc’s results in, or go through the rigmarole of having the patient sign a release. In my younger days, I was in a hurry to figure the case out and didn’t care about money. So if a patient hadn’t brought his past stuff, I just did it all.
The longer you do this job, though, the more you realize how wasteful this is. Ordering labs costs the patient money, costs the insurance company money, and (by extension of increasing premiums) sooner or later costs me money. Plus, why put patients through painful procedures if you can avoid them? They appreciate that kind of thinking. I would, too.
So now, I wait. Most office cases aren’t urgent. I send a release when needed or call the referring physician for past test results. Usually, they show up in 1-2 weeks and I review them. Then, if things are missing, I write out a lab order to cover them and notify the patient.
I still run into younger docs who don’t do this, and just order everything right off the bat. Looking at it with the experience of 15 years in practice, that seems remarkably wasteful. Yes, occasionally you encounter results that should be repeated, but not often.
This is how it was taught in my residency, and still is today. Perhaps it’s an ivory tower view that the referring physician couldn’t possibly have ordered anything of value, or there’s an emphasis in training on quickly cracking the case, regardless of a lack of urgency.
It’s unfortunate that medical training, to a large extent, still doesn’t emphasize the financial realities of ordering duplicate tests. As we all try to provide better health care with fewer dollars, this kind of awareness becomes more important. I suppose it also could be seen as an argument for a centralized medical record system, so that we can all quickly see what’s been done, but I’ll leave that debate for another time.
The older I get, the easier it is to see these issues from the viewpoint of a patient. Who wants to waste money or blood on unnecessarily duplicated tests?
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
I try hard not to duplicate tests. Unfortunately, in my experience, I’m in the minority.
When I started out, I ordered everything in the work-up for, say, neuropathy, at the first visit even if the patient said, "Dr. Smith just did some labs." I was impatient. I wanted to find out what was going on, so I just ordered a complete work-up. I didn’t want to wait a week or two to get the other doc’s results in, or go through the rigmarole of having the patient sign a release. In my younger days, I was in a hurry to figure the case out and didn’t care about money. So if a patient hadn’t brought his past stuff, I just did it all.
The longer you do this job, though, the more you realize how wasteful this is. Ordering labs costs the patient money, costs the insurance company money, and (by extension of increasing premiums) sooner or later costs me money. Plus, why put patients through painful procedures if you can avoid them? They appreciate that kind of thinking. I would, too.
So now, I wait. Most office cases aren’t urgent. I send a release when needed or call the referring physician for past test results. Usually, they show up in 1-2 weeks and I review them. Then, if things are missing, I write out a lab order to cover them and notify the patient.
I still run into younger docs who don’t do this, and just order everything right off the bat. Looking at it with the experience of 15 years in practice, that seems remarkably wasteful. Yes, occasionally you encounter results that should be repeated, but not often.
This is how it was taught in my residency, and still is today. Perhaps it’s an ivory tower view that the referring physician couldn’t possibly have ordered anything of value, or there’s an emphasis in training on quickly cracking the case, regardless of a lack of urgency.
It’s unfortunate that medical training, to a large extent, still doesn’t emphasize the financial realities of ordering duplicate tests. As we all try to provide better health care with fewer dollars, this kind of awareness becomes more important. I suppose it also could be seen as an argument for a centralized medical record system, so that we can all quickly see what’s been done, but I’ll leave that debate for another time.
The older I get, the easier it is to see these issues from the viewpoint of a patient. Who wants to waste money or blood on unnecessarily duplicated tests?
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
