The Patient, the doctor, the beaurocrat and the Test!

     The Canadian Medical Association is a lead partner in this campaign with thirty medical specialty societies collaborating to decide what tests and investigations are appropriate to order on patients.  This campaign is called "Choosing Wisely - Canada" and is a copycat response to "Choosing Wisely" - for some reason Americans don't seem to have to add the - America.  The professed primary purpose of this is to 'help doctors and their patients address unecessary and possibly harmful over-testing and over-treating'.  While this is no doubt part of the motivation, one does not need to be very bright to see what a cost control tool this will be in the hands of the bureaucrats in the Department of Health.    Although it is generally recognized that most tests do contribute to providing good medical care to the patient, some do not and in retrospect appear to be excessive or on occasion even harmful and of course expensive. However that conclusion is more easily determined after the event when the end point has been revealed than in the urgency and sometimes confusion of a potentially serious diagnosis.  It is inappropriate to intimidate a physician under those circumstances, into not doing a test that just may be helpful, because it will likely be normal.  

      Of course there are individuals who misuse the resources through greed or through ignorance and both of these issues must be addressed.  But there are many investigations ordered in good faith when a potentially dangerous situation seems to be gathering momentum and the physician casts a wide net in the hope of capturing some piece of information that may throw light on the situation.  Experience and intuition sometimes save the day and the thought that some administrators, uneducated in medicine but cutting edge in business practice, may be able to squelch these finely developed skills is more than depressing and demoralizing.   It is sad to think that there may soon be no room in the system for the physician who through skill or effort wants to give his patient the best he has to offer.  Uniform mediocrity for all seems to be the objective of these times.

      Apart from such ambitions, every physician wants and needs to protect himself from the avaricious attacks spearheaded by the legal profession which strives to find work for itself by encouraging patients to enter the medico-legal sweepstakes in cases that they know well have no merit other than the one third of any settlement that they might acquire.  Every physician knows that he/she is liable if there is no neck x-ray on record in a cervical whiplash (a legal term originally, I believe), whether or not it was necessary, because twenty five years later if the patient develops osteoarthritis of their cervical spine,it may be attributed to the injury, whether related or not.   Many a physician who tried to conserve resources has found himself accused of less than thorough medical care on account of not having ordered a test that, in retrospect, it might have been wise to do at the time - especially if one wasn't under pressure to conserve.That is not to say that there cannot or should not be some monitoring and restrictions on certain tests and investigations but it will require great care and definition of goals that are acceptable to both the doctor and the patient.

      Finally for today, I must say that I have never met a politician or a medical administrator and I have treated a number of both and their families, over the years, who volunteered to be in the forefront of the initiatives to cut back on  use of such resources.  Nor have I met physicians, nurses or health care professionals who opted for other than their physicians to make the recommendations as to the protocol to follow.

I'd like to hear your view on all of this, because you are the folks who are going to be effected.  Comment, if you would like this thread to continue.