Maybe if doctors weren’t so afraid of getting sued the process would be cheaper and more efficient.  I have this friend (okay, it’s me) who needs a minor test procedure.  She has had a minor chronic problem for years and years.  She’s read up on the problem, spoken to doctors about the problem, knows enough to know when the problem may be getting worse and knows the test needed to ensure that the problem isn’t progressing toward something more serious. 

So, when her symptoms started to get worse, she called her medical group to schedule the needed precautionary test…you know the test that would enable us to see if we could prevent something from getting worse and requiring more care, more dollars, etc.  And, she’s lucky.  She has great medical insurance that doesn’t require a primary care referral before seeing a specialist and doesn’t require pre-clearance of testing.

So, explain why then, when she called her medical group to schedule the test they told her that she had to see her primary care physician first? 

Ok, so she sees her primary care physician who tells her that she probably needs the test in question…the one she knew she needed in the first place.  But first, she has to take a test to see if she needs the test.  What?

Ok, so she takes the test to see if she needs the test…guess what, test #1 showed she needs test #2…no kidding.  Plus, test #1now gives her permission to see the specialist.  She is unclear as to why she needs to see the specialist before taking test #2 (which should have been test #1).  He’s going to tell her she needs to take test #2…which she already knows.  And, knew from the start. 

Ok, so she goes to the specialist (a month has gone by because she has a job, kids, a life…) and guess what…specialist tells her she needs test #2 (which should have been test #1).  It’s good she doesn’t have a heart condition because all these surprises would certainly have been tough on her ticker!  But wait, we don’t know that she doesn’t have a heart condition…we’re going to find out though because before she can have test #2, she has to have an EKG which i guess would qualify as test #1-1/2. 

So, now she’s had 3 doctor’s visits, 2 tests, a bit of bloodwork…all before she goes to have test #2 (which should have been test#1) where, by the way, if there’s a problem it can actually be fixed during test #2 — no separate procedure.  So, what it boils down to is she could have had the ultimate test, gotten a problem fixed and moved on, all in one event.  But that’s not what happened.

So, why all the extra steps?  CYA and $$.  The medical group will surely bill the insurance company for all the prelim visits and conversations.  The test to determine if if test#2 was neded surely costs a pretty penny…and it gives all the MDs the cover they need to show that they didn’t do 1 test, they did 2…in case something gets missed. 

This kind of inefficiency is what drives the costs up.  Frankly, it underscores the access to care some of us have…but if we were saving steps and costs on people with access, wouldn’t we be better able to provide care to others?