Opinion/Letter: Unnecessary tests need deep reform

By Justiniano F. Campa National Source

  • 0
  • August 29, 2019

SOURCE: The Daily Progress

The July 28 issue of The Daily Progress relates the initiative from two young members of the University of Virginia faculty, Dr. Joseph Wiencek and Dr. Andrew Parsons, about reducing unnecessary medical tests.

As a retired neurologist from 40 years of clinical practice, I have to point out that the main reason for those tests lies in doctors’ fear of being sued, an event that can stop and destroy a hard-earned reputation and career.

One of my UVa mentors told us, “If you practice long enough, you will be sued.” This fear might lead doctors to: 1) order more tests, 2) refer patients to more expensive tertiary care hospitals and 3) contribute to the current flight to become hospital employees, where ordering more tests is easy and expected, instead of remaining in independent practice.

Add these three contingencies, and guess what is the additional cost to our health care? A figure for this cost is not readily available and seldom mentioned, truly a political taboo. Yet I and my contemporary colleagues estimate it at 20% to 25%. When one compares this malpractice cost in the U.S. to the likely 3% in the European countries, it is easy to see the huge savings — in the billions of dollars — that could be moved to other goals, like rural health care centers, reduction in the cost of medical insurance for all and affordability for universal health care.

The current medical malpractice settings in our U.S. are an aberration in all European countries. They cannot be solved by computer warnings to doctors or with meek capping of the lawyer’s awards. The best way to deliver all the above-mentioned savings is to replace our current medical malpractice by a self-insured system at the state level, run by each state’s medical societies. This plan has to originate from, and partly be financed by, the federal government.

Such a radical, heretofore never contemplated approach is not politically impossible. A party might carry the idea in the next presidential campaign, and the president could execute it as Barack Obama did with Medicaid.

There are indeed many nuances on this problem, but it is important to start the conversation. I therefore thank Dr. Wiencek and Dr. Parsons for their initiative.