Thursday, October 27, 2005

To test or not to test?

When I consider healthcare now, I see something now that I didn't see before. Doctors are *most concerned* about liability (e.g. negative to the doctor), not incentives to make money (positive to a doctor). Since American society is so litigious, doctors order a battery of tests, needed or not, because they do not want to be sued in the remote possibility that the tests detect an ailment.

It makes so much sense now!

The provision of healthcare is by its very nature an assessment of risk. Doctors and patients have to trade-off the risk and the benefit of expensive tests and treatments.

In a hypothetical situation, let's say a patient goes to a doctor feeling sick. The doctor examines the patient, and based on physical symptoms and descriptions by the patient, the doctor makes the judgment that the patient has a low chance of having a terminal, life-threatening disease. Say a 1% chance. However, the doctor cannot be 100% certain, unless he or she runs a battery of expensive tests.

Since the doctor (1) wants to make sure the patient is healthy and (2) is worried about *not* detecting a potentially serious and being blamed by the patient and subsequently sued, the doctor will order the expensive tests.

The first result (health of the patient) can probably be determined most cost effectively through doctor's own training and experience assessing the potential for disease. But as in most situations in life, nothing is 100% certain, and there is a risk the doctor could have made an error. Since the doctor is afraid, he or she will choose the sure thing, the no-blame course of action, and order the tests. The benefit to the doctor personally far outweighs the costs of the tests, since he or she is *not* going to pay for the expensive (and potentially unnecessary tests).

The patient just wants to make sure he or she is really okay. That there is nothing more serious wrong. As long as the tests are not too arduous or difficult, the patient will likely agree to taking additional tests to *make sure* nothing is wrong. Even though, the doctor might be 99% confident, nothing is wrong.

For the patient, the benefit of taking the test (more certainty around disease status) far outweighs the benefits of not taking the test (saving money and time). The doctor feels the same way.

I don't believe this is the only reason that healthcare costs are skyrocketing, but I do feel it is one reason. As more and more advanced tests become available, able to detect a myriad of rare diseases, don't doctors have a *responsibility* to check their patients in the remote possibility the patient has the disease?

And wouldn't patients prefer to take the tests themselves for peace of mind?

Even if the tests are not really effective or accurate or even better at detecting a disease than simple analysis, the doctor can say, "Hey, I gave the test. Nothing was wrong. I did my duty, so you can't blame me if something was wrong."

There is no incentive for the ones spending the money to reign in these types of costs.

Nothing in life is 100% certain, where do we draw the line at acceptable risk vs. unacceptable risk? At what cost?