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LETTER TO EDITOR
Year : 2014  |  Volume : 3  |  Issue : 2  |  Page : 171-172  

Overuse of various radiological and pathological investigations: Should we be safe or sorry?


Department of Radiology, Sri Ramachandra Medical College and Hospital, Chennai, Tamil Nadu, India

Date of Web Publication29-Jul-2014

Correspondence Address:
Mitesh Kumar
Department of Radiology, Sri Ramachandra Medical College and Hospital, Chennai - 600 116, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2249-4863.137672

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How to cite this article:
Kumar M. Overuse of various radiological and pathological investigations: Should we be safe or sorry?. J Family Med Prim Care 2014;3:171-2

How to cite this URL:
Kumar M. Overuse of various radiological and pathological investigations: Should we be safe or sorry?. J Family Med Prim Care [serial online] 2014 [cited 2019 May 23];3:171-2. Available from: http://www.jfmpc.com/text.asp?2014/3/2/171/137672

Sir,

The use of a number of radiological and pathological investigations as a diagnostic tool for simple ailments has been increasing at an alarming rate within the public and more so in the private sector. Many medical professionals have, time and again, raised the clinical, economical and ethical concerns over such unnecessary use of such facilities.

There are a number of reasons which can be held accountable for this misuse or overuse, as we may call it.

One of the foremost reasons is the diminution in the quality of clinical skills or clinical judgment. This again could be partly attributed to the mushrooming of medical colleges across the globe with decrease in the standard of education in the same. In this respect, I would like to quote Connelly and Steele who have emphasized the need of proper medical education for proper utilization of laboratory tests. [1] I feel that not just laboratory tests, but this theory is relevant for diagnostic investigations as well.

Another and more important factor responsible for this is increase in patient awareness and patient education. With the easy accessibility of ample knowledge over internet, most patients these days play an important role in the diagnostic decisions taken by the clinicians. More often than not, the patients themselves emphasize the need of various tests [2] and compel the clinician for unwarranted investigations.

Yet another component responsible in the over investigation of simple diseases, is the rise in empowerment of patients and increase in the number of litigations against the clinicians. [3] The medical fraternity in order to safeguard themselves practice defensive medicine which in turn compels them to over investigate simple ailments.

One more important and mounting reason for such screenings is the increase in medical insurances and broader medical facilities offered to employees and their family members in various public and private sectors. Who would have thought that these insurances which were originally meant for lowering the overall burden on the economics of a country are actually escalating the burden? When ones medical expenses are covered by third party insurance companies offering more coverage, patients as wells as doctors like to play it safe and this leads to an array of investigations which otherwise could have been avoided. [4]

A small and important element in overuse of different investigations is the financial interest of the doctors. [5] There have been few unendorsed surveys that suggest that doctors with financial interest invested in laboratory and imaging investigations tend to order more investigations than their counterparts who have no such incentive.

It should be noted that there is no substitute for a good clinical examination, however, the trend has become to practice evidence based medicine based on radiological and pathological findings rather than skill based medicine. Each investigation requested should have a proper aim and objective based on the history and a thorough clinical examination of the patient. Clinical examination should be the basis for any diagnostic investigation and not vice versa. It should be kept in mind that these investigations help reach a diagnosis but not necessarily provide diagnosis all the time.

All such indiscriminate investigations not only add to the overall health cost of the nation but also burden the already scarce health care resources in our country. This trend burdens the radiology department and laboratory of hospitals especially during medical and surgical emergencies. The number of investigations ordered and the frequency by which these investigations should be repeated in follow-up cases should be a cumulative decision, taken after a discussion with the radiologists and pathologists. Before ordering such tests, one question that should be asked is whether the investigation is required and would it have any effect on the management in the suspected disease. The chances of discovery of asymptomatic findings which would eventually lead to further series of investigations should be wisely considered.

Many medical societies have formed a foundation for a project called "choosing wisely" [6] whose aim is to establish a health care system where the patients' needs and cost-effective management of the clinical resources go hand in hand.

In the end, I rest my case by concluding that in a country like India, where the average disposable income of people is less and infrastructure and resources are scarce, all investigations should be judiciously decided. There should be steps taken to ensure optimal use of the radiological and pathological resources and to avoid over burdening of the health departments to ensure that we provide better health care facilities to all. Regular audits, developing protocols, continuous educational programs, patients' feedbacks are the need of the hour in the field of medical services in our country.

 
  References Top

1.Conn RB. Clinical laboratories. Profit center, production industry or patient-care resource? N Engl J Med 1978;298:422-7.  Back to cited text no. 1
    
2.Gill VT, Pomerantz A, Denvir P. Pre-emptive resistance: Patients participation in diagnostic sense-making activities. Sociol Health Illn 2010;32:1-20.  Back to cited text no. 2
    
3.Catino M. Why do doctors practice defensive medicine, the side effects of medical litigation. Safety Sci Monit 2011;15:1-2.  Back to cited text no. 3
    
4.Russell LB. How much does medical technology cost? Bull N Y Acad Med 1978;54:124-31.  Back to cited text no. 4
    
5.Schroeder SA, Showstack JA. Financial incentives to perform medical procedures and laboratory tests: Illustrative models of office practice. Med Care 1978;16:289-98.  Back to cited text no. 5
    
6.Choosing Wisely® . Philadelphia: An Initiative of the ABIM Foundation, All Rights Reserved; c2014. Available from: http://www.choosingwisely.org/. [Last cited on 2014 Feb 11].  Back to cited text no. 6
    



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