We'll begin this answer by saying that, yes -- most medical tests the doctor orders for you are necessary to help diagnose your medical problem or determine a treatment's progress.
But not all tests are necessary. Some would tell you that the reason there are so many tests is because doctors no longer trust their own diagnosing capabilities to assess a patient. Therefore, they rely too heavily on test results (which may, or may not be accurate.)
But perhaps even more so, and as we learn too often in healthcare, the more prevalent answer to this question is "follow the money."
There are actually two ways money affects the amount of testing ordered for patients:
First, doctors are paid by insurance companies and Medicare for every patient they see according to why they see the patient and what procedures they perform for her.
Because insurance companies and Medicare limit the amount of money a doctor can be reimbursed for any given diagnosis, and knowing that the real goal is always to stay in business and make money, doctors will often order a variety of tests -- anything they think will be reimbursed for a patient.
More and more, these tests are being done right in the doctor's office. Those tests that we used to go to other testing labs for -- blood tests, MRIs, EKGs, and others -- are now handled even in primary care settings.
The more tests doctors run in their own offices, the more they get paid for, whether or not a patient really needs them. Since we patients are rarely paying directly for them, and since we don't really understand why we need them, we don't question them. We just comply.
The second reason doctors order too many tests is called "defensive medicine." Defensive medicine is the way doctors protect themselves from lawsuits. If some mistake is made in the diagnosis or treatment of a patient, and the doctor can show that certain tests were conducted (whether or not they were needed), the doctor can appear as if he was diligent enough to think of the many possibilities. In effect, he's creating a paper trail to defend himself against the possibility that you will sue him later.
Too Much Testing Will Cost You Money
With the shifting sands of insurance and payer coverages, payment is being denied for more and more of these extra forms of tests. In a case in New York State, doctors were ordering MRIs ($1,000 each) for patients who could have been just as well served by the use of far less expensive x-rays ($100 each). The insurance company began to deny payment, and patients were being billed. You'll want to be sure that any test, whether or not you really need it, is covered by your insurance for your symptoms or diagnosis.
Also, when extra tests are ordered for no more benefit than the doctor's income, we all pay for them. We pay in the form of increased premiums, and we pay in the form of increased taxes to fund government payers. In fact, over-testing costs the system millions, if not billions of dollars annually.
How Can We Prevent Having to Undergo Too Many Tests?
The most useful answer to this question is knowledge. If your doctor orders tests for you, there are a few things you can do:
- For all tests: Ask two questions. What is this test for? And, what do you expect to find?
- For tests the doctor runs in her office (blood work, EKGs, even MRIs), ask the questions above, then ask what that test will answer that another test already ordered may not. Or, ask if there is a less expensive form of a test, or one that will supply enough information but not more than is needed. For example, a doctor might need to measure a diabetes patient's HbA1c by taking a sample of blood. That is one test. But the doctor could order a full panel of bloodwork instead, which is far more extensive, potentially unnecessary and billed at a higher rate (meaning she makes more money. It's up to the patient to figure that out.
- For tests ordered in a lab not connected to the doctor's office, ask the questions in #1 above, but be less concerned about whether those tests are extra, unless you believe they might be included in the defensive medicine category. If the doctor can't profit from extra tests directly, there is less chance you'll have to undergo more than you need. Kickbacks or commissions, where a lab or facility pays a doctor for referrals, are illegal in most states in the United States. Yes, there are certainly examples of fraud. If you have enough energy, you might even pursue that possibility. But as the patient, your number one goal is to get well, not uncover fraud.
- For all tests, ask when the results will be available, and ask that copies of the test results and records be supplied to you.
Learn why "follow the money" is the answer to more doctors' appointments mysteries:
- Why do I wait so long to see the doctor during an appointment?
- Why does my doctor always seem to be in such a hurry? or Why won't my doctor spend more time explaining things to me?
- Why can't I find a doctor who will help me coordinate my care?
- Why does my doctor send me for so many tests?
- Why don't some doctors accept my insurance?
- What is a concierge practice or boutique medicine?