The document discusses 4 ways for doctors to avoid inappropriate medical tests by educating students and colleagues, advocating for administrative changes, engaging patients in treatment decisions, and building collaboration among peers to question unnecessary tests in order to address the large costs and risks associated with overtesting. Inappropriate testing wastes healthcare dollars, can delay accurate diagnoses, and potentially causes patient harm.

1. 4 ways for doctors to avoid inappropriate medical tests
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2. Defining the problem
“If a test doesn’t influence decisions, it’s a waste.”
- Jodi Segal, BS, MD, MPH, Johns Hopkins
• The healthcare system spends $750 billion a year in
avoidable costs
• Inappropriate use of testing can deny the timely
resolution of an accurate diagnosis
• Inappropriate testing causes real harm to patients who
need care

3. The rising cost of diagnosis
Imaging and diagnostics costs are the front-runners in the
rising cost of healthcare
Igelhart NEJM 2009. Vol 360 p1030

4. 98,000 deaths per year due to medical errors
According to a recent study, between 44,000-98,000 people in the
US die from “medical errors” each year. Even using the lowest
estimate, this place medical errors as the 8th leading cause of death
(Corrigan J, Kohn L, Donaldson M Eds, to err is human, Institute of Medicine 1999.)
50,000
40,000
30,000
20,000
10,000
0
Corrigan J, Kohn L, Donaldson M Eds, To err is human, Institute of Medicine 1999.

5. Drivers of Inappropriate Testing
Ask the patient: do you want this test? When you empower the patient, they make
intelligent decisions
- Adam Finkelstein, MD, Swedish Covenant
Time:
Doctors often find it quicker to order a battery of tests than to talk
to a patient or pore over a case
Patient Requests:
Patients often view medical testing as proof that their physician is
giving them a more thorough level of care

6. Drivers of Inappropriate Testing
“Testing needs a rational, deliberate strategy. Before you order a test, you should know what
you will do with the results.”
- Mimi Kokoska, MD, MHCM, FACS, CPE, Indianapolis VA Medical Center
Income:
It shouldn’t be assumed that doctors would order an unnecessary
test purely for monetary gain, but the extra income is probably
appreciated, and not all are enthusiastic to part with it
Liability:
A litigious patient is a scary prospect for a doctor, and a thick paper
trail of tests makes many feel they have insured themselves

7. Biggest problem: The system
“When you build lots of screenings into the system, you get just what you asked for: lots
of screening, regardless of whether it’s useful.”
- Brian Jackson, MD, MS, ARUP Labs
The US boasts a medical community which can supply the latest in
tests and technology, but perhaps access to a litany of tests has
made their ordering rote, diluting pinpoint diagnostic accuracy.

8. Solution #1
Educate:
Work with students and
others around you to
create an ethos of
purposeful testing

9. Solution #2
Advocate:
Ask hospital administrators
and leadership to take steps
towards fostering a
diagnostic testing culture
change

10. Solution #3
Engage:
Encourage your patients to
become a partner in their
health by cultivating
collaboration and treatment
decision support

11. Solution #4
Ask:
Build a standard of collaboration
amongst colleagues and peer
specialists by asking them when
you’re not sure about a test. Don’t
be afraid to say, “I don’t know.”

12. For more on Diagnostic Accuracy…
• Read more on diagnostic error and inappropriate testing at
ClinicalCurbside.com
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