There was an article in The New Yorker (?) a couple of years ago about medical costs. The author, Atul Gawande (?), stated the most cost effective model was Mayo Clinic. They could diagnose illnesses for much less.

I've seen this even with the other moms in my mom's group.

Out of 5 moms, 3 have had workups for their kids to 'rule out' problems.

One's son was sent to the urologist for a workup. It ended up being nothing.

One's daughter was sent for a workup regarding digestive issues, simply because she was underweight. It ended up being nothing.

One's son had tons of workups for allergies. It did end up he had a minor allergy, so that was something.

I have no doubt that they can catch problems earlier, but for the kids who ended up not having any problems, is it really worth all the stress and hardship of dragging your 2 year old all over town for blood work, doctor's appointments, etc. I also feel that the younger MDs seem to be more quick to refer things out at our particular pedi practice. The older pediatricians seem a bit more laid back. So, maybe it has to do with experience. Knowing when exactly something could be a big problem, versus knowing when you can just do 'watchful waiting'. Or, maybe the younger docs are trained to do more testing, and are more worried about lawsuits?

Anonymous wrote:Read "overtreated" by Shannon brownlee

Thanks, I'll check it out.

Anonymous wrote:PP, thank you for posting that. They recommend every 3 years for women age 21-65. I've been to several different OBs over the past few years and they all insist on yearly paps.

I wonder why there is a disconnect. It can't just be about money. How much money can OBs possibly be making on a pap smear?

I will definitely save that link and use it the next time they want to scrape away at my cervix.

Because its a relatively inexpensive and relatively non invasive that could save your life.

Read "overtreated" by Shannon brownlee

PP, thank you for posting that. They recommend every 3 years for women age 21-65. I've been to several different OBs over the past few years and they all insist on yearly paps.

I wonder why there is a disconnect. It can't just be about money. How much money can OBs possibly be making on a pap smear?

I will definitely save that link and use it the next time they want to scrape away at my cervix.

If you have never had an abnormal pap, you def shouldn't be getting one every year anymore. http://www.uspreventiveservicestaskforce.org/uspstf/uspscerv.htm

Anonymous wrote:

Anonymous wrote:I've read a bit about this regarding prostate cancer because my dad has had for over 20 years.

There seems to be some more controversy now whether all the extra PSA screenings are actually beneficial.

Same thing with paps and mammograms.

Are there any studies that show the effectiveness of yearly paps. I don't think here is any way I could get my OB to go even one year without a pap.

Anonymous wrote:I've read a bit about this regarding prostate cancer because my dad has had for over 20 years.

There seems to be some more controversy now whether all the extra PSA screenings are actually beneficial.

Same thing with paps and mammograms.

I've read a bit about this regarding prostate cancer because my dad has had for over 20 years.

There seems to be some more controversy now whether all the extra PSA screenings are actually beneficial.

There has been a long standing debate between US and European clinicians about screening. The truth is doctors in the US don't want to not test because it could save someone's life or prolong it. Europe doesn't want to test unless they have to because of the costs involved. Several studies have called it a draw. The US continues to try to provide the best care possible and keep doing research on the best way to screen and identify high-risk patients.

That seems to be the jist of it -patients like their docs better if they're ordering every possible test under the sun. Makes them feel that the doc is proactive?

Definitely feel that there is an element of doctors wanting to cover their asses also.

Makes me think twice about going to the doc though! I've actually been really happy with my kids' pedi because he doesn't seem to want to go nuts and test for every little thing. I think I trust him more because of that. I feel that if he does cAll for a test it must really be needed.

Here is another article from while ago that says the same thing.

http://news.yahoo.com/s/ap/20100607/ap_on_he_me/us_med_overtreated


My personal feelings are most of this is due to doctor's playing defensive medicine. They are afraid of getting sued so they rather do the million dollar workup, than to think critically and only do tests that are necessary. Plus many patients LOVE tests and feel they are getting better care if they get to do a bunch of unnecessary and unrelated tests.

Sometimes when a patient wants to hold off on, or opt out of a test, they are met with hostility from the provider, because again the provider is worried about covering their ass.

Isn't this the same argument from those who feel the C-section rate is too high. Pregnancy is treated like a 'condition' rather than a natural event. Too many interventions (pitocin, inductions) often leading to an overuse of C-sections.

I had a C-section myself, so I'm not in any way trying to insult women with a C-section.... just that I wonder if it could have been avoided.

Interesting article on how we often get prescribed too many drugs, and end up being overscreened for everything. I work in a healthcare office and see this all the time. Patients come in demanding antibiotics, even though most things will just resolve on their own. And, the doctors often feel the need to give in so the patients are satisfied.

When my own DD went to the ER, they ran all sorts of unnecessary tests (CT scan, etc) that I found out later were unnecessary, and definitely overkill (from our regular doc).

http://www.nakedcapitalism.com/2012/03/dying-for-satisfaction-being-happy-with-your-doctor-is-bad-for-your-health.html