Incentives promote unnecessary, excessive tests in the ER


A professor of medicine visits the emergency department with a seemingly routine case of shingles, and gets the million dollar workup.

Writing in the Washington Post, Jack Coulehan describes how he was subjected to neurology and ophthalmology consults, several MRIs, and a CT scan. All for shingles, a disease that is diagnosed clinically, and treated with an anti-viral medication, pain relievers, and in some cases, steroids.

Soured from the experience, Dr. Coulehan writes that “I’ve lost the smugness and condescension I often felt when listening to others’ stories about being trapped by the system and manipulated into excessively complex and specialized medical situations. Unlike most of my patients, I actually knew what my diagnosis was and what to do about it, but I learned how difficult it is to remain objective when you’re feeling very sick.”

That’s true. Many patients in the ER won’t dispute or object to tests that doctors recommend they undergo. But not mentioned are the countless times where patients are counseled not to have a specific study, only to have him find another doctor to order the unnecessary test.

There is very little disincentive, for both patients and doctors, to pursue excessive testing. And there’s no hope for cost control until that changes.


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