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Dare to Ask: More tests don’t mean more money for doctors 

By Phillip J. Milano

Question

I’ve noticed many doctors exaggerate what to do with my “problems,” such as suggesting unnecessary operations, until I find ones who tell the truth. Don’t they swear to help, be honest and good? Why try to just get more money from us by lying? Shame on you!

Nickynic, female, Venezuela

Replies

Especially here in America, there’s no such thing as an accident or an act of God. If your doctor missed something and you wind up getting sicker or dying from it, squadrons of lawyers are more than happy to help you or your next-of-kin [take] the doctor for every cent he or she is worth. Your doctors aren’t greedy, they are covering their [butts] by recommending lots of tests, and even procedures that might prove unnecessary.

Ann, 38, Kansas City, Mo.

It’s always smart to get a second or third opinion before you have something major done that will cost money. It’s kind of like the car dealerships and getting your car fixed.

Ryan, Fargo, N.D.

My dad was a wonderful doctor and, although he was never sued, he had to pay huge malpractice insurance premiums.

Shirley, 50, St. Louis

If all you have is a hammer, everything looks like a nail. Generally surgeons, being trained to solve problems surgically, recommend surgery. Internists are trained to use drugs, etc. … None is being dishonest, they just have different perspectives.

Amy, 42, Philadelphia

Experts say

Why would physicians order a ton of tests or procedures that are almost never done on-site and get billed to some other facility if they’re trying to make extra dough off it?

So asks Jacksonville allergist Sunil Joshi.

“If I were a physician who ordered a colonoscopy, I don’t benefit from that, the gastroenterologist benefits. Or a CT scan of the sinuses. I don’t benefit from that,” he said. “On the flip side, let’s say I do order something being done in the office, like an EKG or a chest X-ray; yes, the test gets paid for, but I wouldn’t think most physicians do that just to make money. I would say it’s done for appropriate reasons.”

Plus, there’s a federal law that prohibits you from sending tests to facilities owned by your own practice, so you’re prevented from gaining financially that way, too, Joshi added.

On the other hand … yes, the threat of a lawsuit can play a role in a physician’s mind when it comes to care. It might cause a doctor who is “on the edge” of whether a test is needed to order it to be safe, as well as do what’s right for the patient, he said.

“Medical malpractice in this country is a huge reason for the cost of health care,” Joshi said. “A physician … may decide to do the test to rule out a bad diagnosis and protect himself from a potential lawsuit down the road.”

Ellen Rieback, a South Florida registered nurse who’s been a medical expert witness for nearly three decades (medicalexpert.com), does not completely concur.

Most doctors are good and admirable and all that, she said, and most don’t order pointless tests, but there are enough out there who do procedures because “they can bill for it,” she said.

Take Florida, for example. The whole “ordering tests for self-protection” argument doesn’t always ring true when the state requires docs carry malpractice insurance, then allows them to skirt that by proving they have just $250,000 set aside for lawsuits. Plus, it also offers other loopholes, too.

“So some don’t have malpractice insurance and then shelter their assets, like putting them in their wives’ names,” Rieback said. (Joshi argued, however, that Florida malpractice premiums, while high, have actually declined with new damage limits, so more doctors can afford them now.)

But if some physicians do shield their assets and carry little or no insurance, are they really just being greedy ordering all the procedures?

It all comes back to the myth that doctors are swimming in truckloads of money, Joshi said. Combine lower insurance reimbursements with mountains of student debt, and a lot of doctors, especially younger ones, are definitely not filthy rich.

But that’s just what drives up the incentive to order more and more unneeded procedures, Rieback countered. And some procedures? They bring in a bunch more money than others.

“Look at C-sections. They often make more money doing them. And it’s more convenient. They don’t have to be there at night, they can just schedule it,” Rieback said. “Or what about bariatric surgeries? I mean, people don’t just blow up [their weight] overnight; they have to shove the food in their mouths. … But instead of suggesting a diet, a doctor can make big money doing an operation.”

After all, Rieback said: “It’s not the art of medicine. It’s the business of medicine.”

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