Tests often ordered when not needed

A study shows that unnecessary screenings add up to a big price tag as physicians and patients decide it's better to be safe than sorry.

By Kevin B. O'Reilly, AMNews staff. June 19, 2006.

More than 40% of routine office visits for preventive health exams result in physicians ordering unnecessary laboratory tests and procedures, costing as much as nearly $200 million a year, according to a study in the June American Journal of Preventive Medicine. (See correction)

Researchers and experts cited physicians' lack of familiarity with evidence-based guidelines, patient pressure on physicians to order superfluous tests and doctors' fear of medical liability as culprits for the problem.

The study examined data collected as part of the National Ambulatory Medical Care Survey from 1997 to 2002 for office visits where patients said they were visiting for a general exam, the reason listed for the visit by the physician was non-illness care, and the only diagnosis code was for a general medical exam.

Urinalyses, for example, were ordered nearly 37% of the time, even though the U.S. Preventive Services Task Force, an entity within the U.S. Dept. of Health and Human Services, recommends against routinely providing the test to asymptomatic patients. X-rays and electrocardiograms, which the USPSTF also recommends against using as routine screening tools, were each ordered in fewer than 10% of visits.

Complete blood counts, which the USPSTF doesn't recommend for or against, were ordered during 27% of physical exams. Hematocrits, also on a USPSTF list that doesn't recommend for or against, were ordered during 17% of physical exams.