Are doctors ordering too many tests, or practicing a new standard?

by Kevin Pho, MD

Are medical students and new doctors overly reliant on tests and technology to make diagnoses?

That’s an interesting thought I had when reading the latest TIME.com piece from emergency physicians Jesse M. Pines and Dr. Zachary F. Meisel.

In their article, they give reasons why doctors order too many tests.

Of course, they cite defensive purposes, saying, “once a doctor has presented an M&M [morbidity and mortality], she will probably never make that same mistake again — but she may start ordering more tests on her patients for minor symptoms.”

More interesting is how they say young doctors have grown up and learned with medical technology readily available, and have grown to depend on them:

Radiology tests have become a crutch: doctors in training are no longer taught how to distinguish patients who need testing from those who don’t. A decade ago, a surgeon would spend time interviewing and carefully examining a patient to help decide if he or she needed a CT. Now, many surgeons, especially the younger ones, won’t see a patient until the CT is complete. Testing has become more of a reflex than a higher-level decision … Could it be that younger doctors are simply less likely to view imaging tests as defensive, considering them instead as the standard way to make a diagnosis?

In a recent New York Times op-ed, Stanford physician Abraham Verghese echoes this sentiment. He has written extensively about the iPatient, and how computers and technology has made the doctor-patient relationship more opaque.

In his piece, Dr. Verghese notes that,

[physical exam] training can be undone the moment the students hit their clinical years. Then, they discover that the currency on the ward seems to be “throughput” — getting tests ordered and getting results, having procedures like colonoscopies done expeditiously, calling in specialists, arranging discharge. And the engine for all of that, indeed the place where the dialogue between doctors and nurses takes place, is the computer.

It seems that medical students today are spoiled by the easy access to the latest in imaging equipment and medical technology, and have become less dependent on physical exam skills previously relied upon in the past.

That, perhaps, is the bigger driver to the increased reliance on tests, rather than the threat of a malpractice lawsuit.

Drs. Pine and Meisel may be on to something. Instead than seeing today’s test-ordering as “overtesting,” doctors may simply be practicing according to a standard of care they’ve become accustomed to.

USA Today

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