Doc Calls For End To High-Cost-Test Addiction

Dr. Sean Palfrey of Boston Medical Center and the Boston University School of Medicine argues for a return to basics. (dmason/Flickr)

BOSTON — Massachusetts, along with the rest of the county, is trying to find a way to make health care less expensive. One way to do that is to limit the use of expensive tests, many of which are often unnecessary. But can doctors — especially young doctors — break that habit?

One Boston doctor says they should.

In an article Wednesday in the New England Journal of Medicine, Dr. Sean Palfrey of Boston Medical Center and the Boston University School of Medicine argues for a return to basics. He says the health care system should move away from relying so heavily on high-tech testing.

But in an interview with WBUR’s All Things Considered host Sacha Pfeiffer, he acknowledges that for many doctors, that won’t be easy to do. A main reason for that, he says, is that “we’re at a time in history when we’re faced with a huge amount of scientific and technological information, and the health care system doesn’t know how to use it best.”

Sacha Pfeiffer: This overtesting problem is something you care very deeply about because it’s something that you see the results of in your day-to-day practice. Can you talk about how that plays out on a daily basis?

Dr. Sean Palfrey: The effects are two- or three-fold. On the one hand, most tests cause pain. Second, they may give us information either we don’t want or that is confusing, And, third, because they do cost millions and millions of dollars, I think they’re part of the reason why we are unable to cover all of the children and all of the adults in this country with health care.

Many doctors worry about the danger of not performing a test or performing a test too late. Do you think doctors overestimate that danger?

They don’t want to miss anything, and so they want to cover all possible bases by doing testing and investigating thoroughly. They do it also because they aren’t given the time by the health care reimbursement system to spend time thinking or to see the child again or the patient again. So follow-up without doing testing is actually considerably cheaper in some ways, but more expensive in others.

You’ve written that doctors must “rediscover the value of clinical judgment.” Are you saying, ‘Forget the fancy tests; just use your stethoscope, or just feel the neck glands, or just feel that swollen abdomen’? Are you saying get back to the simple laying-on-of-hands of doctoring?

We need to use all the technology that we’ve got but we need to use it sparingly and intelligently. Doctors need to understand and learn the benefits and the adverse effects of new fancy tests.

But don’t patients expect fancy tests at this point? Haven’t patients been conditioned to think, ‘If all the doctor did is put a stethoscope on my chest, how could he possibly have diagnosed me correctly?’

That’s part of what this paper is saying: we need to educate families that more medicine is not better medicine. We need to teach them also that there are some problems with actually doing studies, like the CAT scans that are now so much discussed. We did them like water because they gave us good information, but they were costly and they created a lot of radiation exposure.

But, in the meantime, fancier and newer and higher-tech diagnostics are coming out all the time, so you seem to be fighting the tide here.

No. I think we need to use those fancier diagnostic tests when we need them. We have the opportunity in the U.S. to use the technology and the knowledge that we have so effectively that we create the best health system in the world. But we are not doing that right now.

And you think if we do do that, we actually can create a lower-cost health care system that also gives people better treatment?

Correct. A more balanced health care system will be more effective and less costly.