ER Doctors Feel Pressure to Overtest

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Fear of lawsuits often prompts emergency room doctors to order tests that they may feel are unnecessary, the Associated Press reports. In the fast paced environment of an emergency department, making quick decisions that can have life-altering implications is a standard aspect of treatment — and the pressure not to miss anything is acute. Fear of getting sued and the fact that, in a hospital setting where every moment counts, it’s often more expedient to order a test than to try to coax the necessary information from an ailing patient, often prompt doctors to opt for tests — even if they aren’t convinced they’re needed. That pressure, coupled with the fact that patients often push for tests creates an environment where overtesting — and overtreating — are increasingly commonplace.

Explaining the benefits and drawbacks of testing — which include potential risks associated with cumulative radiation exposure — can be time-consuming, and often patients are anxious for quick, definitive action. As Dr. Angela Gardner, president of the American College of Emergency Physicians, tells the AP, patients often feel that tests yield more concrete answers than doctors’ physical exams:

“Our society puts more weight on technology than on physical exams… In other words, why would you believe a doctor who only examines you when you can get an X-ray that can tell something for sure?”

Emergency room doctors are among the top 10 specialists to be sued for malpractice, the AP points out, a fact that many doctors are keenly aware of when the opt to err on the side of caution by ordering tests. Yet, in addition to the additional cost, there is growing concern about long-term health risks of excessive medical testing.

As Dr. Jeffrey Kline, an emergency doctor from Charlotte, N.C., tells the AP, as people are rushing around in the hectic emergency room environment, there is seldom time to explain to patients that the CT scan they just underwent… “just imparted three years of radiation to your body as well as significant stress on your kidney, and Medicare just got charged lots of money.”

While emergency room doctors may be most motivated to overtest by expediency, fear of lawsuits and pressure from patients, in a heartbreaking piece for the New York Times Katy Butler writes that sometimes decisions that err on the side of overtreatment fall uncomfortably in the intersection between optimal patient care, optimal physician compensation and the at-times misguided belief that life extension is always patients’ number one priority.

Despite his crumbling quality of life due to significant cognitive and physical decline, Butler writes that her father kept hanging on well past the stroke he suffered at age 79 — thanks to a pacemaker that she isn’t entirely convinced he would have wanted if he had been able to speak up for himself. Yet even for patients who might have the opportunity to defer a potential treatment, information that might impact their decision isn’t always provided. Butler writes:

“According to an analysis by the Dartmouth Atlas medical-research group, patients are far more likely than their doctors to reject aggressive treatments when fully informed of pros, cons and alternatives — information, one study suggests, that nearly half of patients say they don’t get.”

Read the full AP story here. Read the New York Times piece here.