More Is Better?

Trevor dropped a stack of papers on my desk as he waltzed into the office.  An athletic 45 year old, most of his care had been routine till now.  I placed  the  computer down and flipped through the pages.  The first, a stress echocardiogram, was normal.  The next was a lab report with a cholesterol panel, and the last was a consultation from a cardiologist.

I looked up dissapointedly.  Nothing bothers me more than when a patient gets a bunch of diagnostic testing without my knowing about it.  I waited quietly for an explanation.  Trevor spoke hurriedly to fill the void.

I got this flyer in the mail.

Apparently the mammoth university owned medical group sent out a mass mailing.  Trevor, who had a distant family history of coronary disease, responded positively to the simplistic questions on the front cover and called to make an appointment.  Presto!  A few days later he was sitting in front of a cardiologist.  Although he had a paucity of cardiac risk factors, there was this strange jaw pain (previously diagnosed TMJ) and this tingling in his left thumb (soon to be diagnosed carpal tunnel).  The cardiologist sent him for a stress echocardiogram (not a stress electorcardiogram which was the more appropriate test given the normal EKG).  He also checked a cholesterol panel which was marked as abnormal because Trevor's LDL was 120.  According to the cardiologists laboratory a normal LDL is no greater than 100 (my goal for non cardiac patients is usually 130-150).

Thankfully, Trevor had not filled the prescription for Lipitor that was called into his pharmacy.  He also hadn't yet made an appointment for a followup with the cardiologist.  I spent the rest of the appointment trying to undo the harm that had already been done.  I couldn't, however, unspend the thousand dollar bill that his insurance company had so dutifully paid.

We are headed for disaster!  Obamacare, with it's noble intentions, has already led to the mass proliferation of humongous hospital owned medical groups.  The downward pressure caused by increasing technology and reporting requirements will likely bankrupt the small practitioner.  What will be left is large, businessman driven, revenue generating health care. 

Are we ready for more is better?