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  1. http://www.cknj.com/articles/2006/11/13/news/news03.txt
    Because of cases like this everyone that enters the ER with any type of chest pain will receive a 60 slice CT to rule out aortic dissection, CAD, etc. Just another piece in the complex puzzle why healthcare costs keep going up.
    This is another big piece of the puzzle. “The hospitals and the doctors are not making any money to speak of, but the person in the middle, who is the paper pusher, is making all the money,”
    http://www.syracuse.com/business/poststandard/index.ssf?/base/business-6/116323951182150.xml&coll=1

  2. I work in the military and order multitudes of CTs, ultrasounds, and other imaging. No cash-cow or cha-ching here just practicing medicine. I would like to see a nonpartisan fair study comparing the use of imaging between the private sector and the military/TRICARE.

  3. Reponse to Miss Kitty-
    I’m curious by what authority are you making the statement ‘pts are being over-tested for over-billing’. I agree w/ Gregory that evidence based medicine needs to challenge everything we do, but be very careful of the generalization “doctors hear a cha-ching” for over-utilization. How about ‘if I don’t do a test, i.e chest CT for a mildly abnormal lab test (D-dimer), in the context of chest pain which clinically does not look like a PE, am I going to wind up in court next month for failing to rule out a diagnosis w/ a less than 2% probability…because if you have it, its a 100% probability. And if I find a PE, it’s going to make it a little easier to order the same test next time…and we all have found a haystack needle at one time or another.
    It’s extremely easy to sit back and decide cost-effective policy if you’re not the one ordering or not ordering a test, and bearing the liability for failure.

  4. Reponse to Miss Kitty-
    I’m curious by what authority are you making the statement ‘pts are being over-tested for over-billing’. I agree w/ Gregory that evidence based medicine needs to challenge everything we do, but be very careful of the generalization “doctors hear a cha-ching” for over-utilization. How about ‘if I don’t do a test, i.e chest CT for a mildly abnormal lab test (D-dimer), in the context of chest pain which clinically does not look like a PE, am I going to wind up in court next month for failing to rule out a diagnosis w/ a less than 2% probability…because if you have it, its a 100% probability. And if I find a PE, it’s going to make it a little easier to order the same test next time…and we all have found a haystack needle at one time or another.
    It’s extremely easy to sit back and decide cost-effective policy if you’re not the one ordering or not ordering a test, and bearing the liability for failure.

  5. Agree– patients are being over-tested mainly for over-billing purposes-
    Doctors hear ca ching ca ching – when the patient has the slightest history to justify over utilization of testing procedures — and throw in a good insurance policy

  6. Serial radiographic imaging studies, CT scans, MRI scans, PET scans, and ultrasound, are very expensive tests. In cancer medicine, the idea of their us is to follow the size of the patient’s tumor while the patient is receiving repeated courses of chemotherapy to determine whether or not the treatment is working and whether or not different drugs should be given, instead. This is an entirely unproven benefit, and were appropriate studies ever to be performed, there wouldn’t be any measurable benefit at all, in terms of improving patient response to chemotherapy or patient survival with chemotherapy. No wonder health care costs keep exploding!

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