Unnecessary workup in the emergency department

WhiteCoat gets worked up (sorry, couldn’t resist) about defensive medicine in the ED, and how easy it is to order copious, expensive tests.

The problem is, if you are thoughtful and decline performing shotgun testing, the next doctor would gladly oblige the patient and order the studies that may not be necessary. Patients do not quite appreciate the specter of the false positive:

There aren’t a lot of people who see anything wrong with doing “more” workups. More testing. More medications. More treatments. Do more for me. That’s all fine until there’s a false-positive test that requires additional follow up testing. Then maybe you have a severe allergic reaction to the contrast. Maybe your biopsy site gets MRSA. Or maybe you get a surgery when you didn’t need one and have a complication from the surgery. Suddenly more isn’t better.

Every incentive, ranging from financial to legal, is focused on doing more. Doctors who order every conceivable test are praised for being “thorough”; judicious doctors are vilified and sued for missing a single diagnosis.

It’s no wonder why costs are going through the roof.

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