The Cost of the Doctor’s Pen

“Will that test change your management?”

This question is one of the best pieces of advice I have ever received.  Each time I order a test or write a prescription, I try to ask myself if it will make my patient healthier or feel better.  When I use my high deductible catastrophic insurance plan to see my doctor, I wonder the same thing.  My patients who do not have insurance want to know if the test I order for them is worth the cash they will have to pay on the way out.

  •  Routine complete blood count in adults (56% of visits): $32.7 million
  • Basic metabolic panel in adults (16%): $10.1 million
  • Annual electrocardiogram (ECG) (19%): $16.6 million
  • Urinalysis (18%): $3.4 million
  • Antibiotics for viral pharyngitis (41%): $116.3 million
  • Cough medicines for children (12%) : 10.3 million
  • Brand name statins (atorvastatin or rosuvastatin) instead of generic statins (34.6%): $5.8 billion
  • Pap smears for patients younger than 21 years (2.9%): $47.7 million
  • Bone density (DEXA) scans for women younger than 64 years (1.4%): $527.4 million
We cannot escape the cost of healthcare.  The cost of all those unnecessary little tests add up to $5 billion/year.  As a doctor, I have to take responsibility for the decisions I make daily.  I can think of many better ways to use this money that will save lives or improve our health.
Why not get our money’s worth?

Kale MS, Bishop TF, Federman AD, Keyhani S. “Top 5” lists top $5 billion. Arch Intern Med 2011;171(20):1856-1858.

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