Are physicians relying too much on medical tests?
A reporter for the Wall Street Journal recently investigated medical laboratories that handle thousands of specimens sent to them from doctors around the country. He found, in many cases, overworked and unsupervised technologists who are paid according to the number of slides they read and tests they perform. Sometimes the work is done in a laboratory where the average review consists of more than twenty-five specimens an hour. Others worked at home, surrounded by domestic distractions and a less-than-ideal scientific environment.
The problem, according to the Journal reporter, Walter Bogdanich, is compounded by the negligence of physicians, who sometimes rush through their part of the procedure, failing to collect cells from the interior of the cervix, in the case of a gynecological test, or neglecting to preserve the cells properly. Consequently, the Pulitzer Prize winning journalist extracted an admission that as many as forty percent of cervical cancer cases may go undetected.
The Pap smear has been acknowledged by many physicians to be unreliable. The skin test for tuberculosis is so untrustworthy, that the Centers for Disease Control, in Atlanta, Georgia, estimates that over a two-year period, forty-two thousand individuals have been treated with isoniazid, an anti-tubercular drug costing about four thousand dollars for therapy that has been implicated in causing liver damage -- the consequence of one defective skin test.
Many patients are needlessly taking medications to reduce blood cholesterol levels, if another investigation is characteristic of laboratory results. In 1985, the College of American Pathologists reviewed five thousand medical laboratories that were asked to evaluate cholesterol values. More than half failed to obtain results within an acceptable margin of error.
In assessing the reliability of laboratory tests in general, the Center for Disease Control has found that as many as one in seven may be erroneous.
Considering that, in 1987, nearly forty-three million tests were performed daily, the probability of misleading diagnoses reaches an astronomical figure approaching two billion yearly!
When that figure is regarded with relation to costs of office visits, hospitalization, and medical tests, the horrors of waste and malpractice add to the nation's financial distress and human agony.
Part of the problem can be attributed to inadequate enforcement of existing regulations of medical laboratories. Few state governments police established quality standards. Even in areas where some strictness is demonstrated, like in New York, the regulatory procedure relies on the honesty of the commercial laboratory. When mistakes are found, the state imposes neither sanctions nor penalties.
The federal government, however, monitors only laboratories that engage in interstate business and those that receive Medicare reimbursement (a tiny fraction of the testing centers in the nation).
Congress recently passed legislation imposing uniform national standards for the accuracy of all tests and requires laboratories to be licensed and inspected annually by state regulators. It is now the responsibility of the states to enforce their own rules for medical testing.
Another urgency exists, however. In a recent survey conducted by the American Medical Association, three-quarters of the responding physicians conceded that they order more medical tests than are truly necessary. Their reasons: to pacify patients, establish a record of thoroughness, and to cash in on the lucrative business of testing.
To relieve the flood of tests that overload laboratories, to diminish the soaring costs of medical care, and to bring back doctors into using their knowledge and training for diagnosis, physicians would be wise to become more prudent in their use of testing before future intervention by various agencies that will leave them no choice.
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|Publication:||Nutrition Health Review|
|Date:||Sep 22, 1989|
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