I applaud Helen Walsh for her recent post about walking away from yet more invasive testing. Her post made me reflect on recent cases of medical expense from my own practice.  Patient details have been altered to protect their identities. 

One patient has an annoying condition that gives him pain with some activities, related to past minor trauma.  This ailment is an inconvenience but in no way threatens his life or livelihood. After basic investigations, I sent him to the local specialist (200kms away, the taxpayer not only has now paid for the basic tests and the consult, but a travel grant as well) who said that further treatment was not necessary.  The specialist felt (as I do) that intervention would be as likely to worsen his condition as improve it.  My patient was not satisfied with this, and, being relatively well off with family in Southern Ontario, he asked me to refer him to a specialty clinic for another opinion. The clinic will not make an appointment unless he's had an MRI.

Sending him for an MRI will cost the taxpayer thousands of dollars.  There will be hundreds more for the trip and consult in Southern Ontario, perhaps thousands more if the sub-specialist agrees to operate. 

This story is repeated daily in Ontario.  Expensive tests are often a prerequisite for seeing a doctor. Some patients go for second (and third…) opinions when they don't like the results of the first.

Another patient had pain on one side. An ultrasound did not show any abnormality on that side but showed a possible cyst on the other side.  CT scan recommended.  The CT showed that the cyst was simple and undoubtedly benign, but that there was a "hypodense" area in another area which was potentially nasty.  Consult and biopsy recommended.  That part of the body is no longer handled by local general surgeons, so the patient made the long trip to the big city. This specialist did see the patient first, but then ordered an MRI.  The MRI did not show the abnormality, so they decided to repeat the CT scan (we are now up to thousands of kilometres driven, 5 travel grants, thousands of dollars and radiation equivalent to 600 chest X-rays).  There was no longer a "hypodense" area on CT, but the radiologist wondered about some thickening in another region and suggested another, more invasive test.

This story is repeated daily in Ontario. Expensive tests reveal "incidentalomas". Patients have to go for second (and third…) investigations when their doctors don't like the results of the first.

Needless consultations and investigations account for a huge proportion of our health care costs and may cause harm. How can we get this under control?