A New York Times writer thinks we do too many tests and not enough healing. She's certainly on trend. But is she right?
In Sunday's Times, Dr. Elisabeth Rosenthal mentions some of the tests that have had their recommendations scaled back or eliminated by medical groups (including the PSA, recently given a "D" grade by the USPSTF), and wonders whether the "ritual physical exam" shouldn't get similar treatment.
"I have not gotten an annual physical since around the time I finished my medical training in 1989," she says. "I respect my doctors, but I see them only when I’m sick."
Rosenthal thinks we overtest in general. She hits the expected points: Americans get a lot of tests that aren't useful, yet fail to get "the few screening tests that are recommended — like a colonoscopy once every 10 years for those over 50 — because of high costs"; the "therapeutic cascade that follows each test" can lead to negative results; many testing decisions are influenced by available technology and expectations, not by need.
Rosenthal's is one of those helicopter pieces that assess large problems very well, but fail to prescribe solutions a typical provider could use. It's one thing to judge that a patient doesn't need a test, but another to take responsibility for the chance that you'll be disastrously wrong about it. The decisions that would fix this have to be made at the medical policy level rather than at the practitioner level. And the way the politics of health care reform is going, it's unlikely that anyone at the top is going to make those kinds of decisions anytime soon.