The tough part about being a doctor is doing what seems right versus doing what is deemed, at least for the moment, right. This article intrigues me because it discusses the issue of what is called “low-value” health care services. They supposedly “run up costs, but aren’t always very helpful.” So which ones are they talking about? Here are some:
- Hormone tests for thyroid problems
- Imaging for low-back pain
- Imaging for uncomplicated headache
Let’s take the contrarian view for a moment. I actually screen for thyroid disease. A TSH is only $10 in my office and I found a ton of thyroid issues in my patients. Autoimmune disease seems to be exploding but I will leave that alone for now. Why aren’t we screening for thyroid disease now? I guess because the USPSTF at this time doesn’t recommend it probably because it is much costlier in other offices and insurers don’t want to pay that cost. Are there many false positive high TSH levels on tests? Not really and a retest in a few months won’t fiscally hurt if it is only $10. In other words, since I can keep the test cost low does that take it out of the low value category? I believe it would. Other offices charging $100 can’t get away with ordering it. So people go unscreened. Does that matter? Well, ask the woman I just found with a TSH of 48 who was thin and no other major thyroid symptoms. How many others will be missed just because doctors or hospitals want to charge so much for a lab?
I get that X-rays and CT scans come with risks and so I understand that over imaging is an issue. My problem is when we get too aggressive with grading out the things we do and it ends up calling everything a low value service. Pretty soon they will be calling the yearly physical a low value service. Oh, yeah, they already are.