My teachers in medical school and residency did not take kindly to me ordering extra tests for patients.
You don't order tests that you don't need, they would tell me. Because when you're not following a logical path, but just poking around for what might come up, you can end up with bad conclusions, bad results, and wasted resources.
However, a recent article in the New York Times reminded me that medical providers are "tricked", guided, and incentivized to order extra tests at every turn. Dr. Zuger looks at how, these days: "Guidelines mandate tests, and patients expect them; abnormal tests mean medication, and medication means more tests."
No one is tricking us, and yet the system can influence us to make decisions we might not otherwise make-- no one's fault but everyone's problem.
Why does this happen, when most medical providers know better? Dr. Zuger says that "As in education, our test-ordering behavior and our patients’ results increasingly define our achievements, and in the near future our remuneration is likely to follow." Plus, most of the technology we use doesn't help either. EMRs routinely spit out demands for tests that may not be necessary and this kind of poorly designed technology can skyrocket costs in the end.
In medicine, “true quality is extremely hard to measure,” Dr. Welch writes in a related article, “What is easy to measure is whether doctors do things.” And although pay-for-performance may not get at "true quality" completely, it certainly seems like an improvement from the current direct incentives for providers to shower patients with tests in a pay-for-services system that is not intrinsically bad, but is broken.
Ultimately, each of us can only guide our own behavior. When we choose to collaborate, use our EMRs in discerning ways, and let our good sense override the metric of the day, that's when we're contributing to a culture of extraordinary medicine. We see iClickCare as supporting those choices, but ultimately, you can do it with or without a tool to help you -- the important thing is following your own heart, training, and intellect.
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Photo by tyfn on Flickr, used under Creative Commons rights