Five Reasons Why Doctors May Order Unnecessary Medical Tests
When your doctor orders a variety of diagnostic medical tests, but you don’t understand the reasoning behind them, you might wonder if you really need all of those tests.
When you go to the doctor, your number one priority is your health. The vast majority of the time, your health is the number one objective of everyone on your medical team too. But, you might be concerned that your doctor is ordering unnecessary tests that won’t benefit your health. While most of the diagnostic tests your doctor orders for you are necessary, there may be some grey areas.
Are All These Tests Necessary?
Most of the medical tests your doctor orders for you are part of the diagnosis of your medical problem, and they help determine your treatment plan. There are valid reasons for having multiple diagnostic tests, but sometimes doctors order tests that are not truly necessary.
There are several reasons that explain why doctors may order too many tests.
1. Limited Accuracy
Each diagnostic medical test can provide helpful information, but they aren’t always completely accurate. Medical tests are inherently limited in their reliability. For example, your blood sugar can provide an idea of whether you have diabetes, whereas a hemoglobin A1C provides insight into your blood sugar levels over the past few months. You and your doctor may find it helpful to know if your blood sugar is elevated during the blood test, but if you can have the test that evaluates your blood sugar levels for months as well, then the result is more valuable in making long-term treatment decisions.
Screening tests are typically unnecessary from the standpoint of your symptoms, but they are used as a means of disease prevention. So even if you don’t have signs of colon cancer, a screening colonoscopy is recommended after age 50 because it can identify asymptomatic colon cancer in time to save lives.
3. Defensive Medicine
Every symptom can mean different things, and all doctors are aware that patients may sue them if a diagnosis is missed. For example, a cough can be the sign of a mild self-limited cold, or it can be the first sign of metastatic lung cancer. Even if your doctor is 99 percent sure that you don’t have cancer, the fear that you might sue if you find out that you have lung cancer five or even 10 years down the road is enough to make many doctors order a chest computerized tomography (CT) scan, even for a mild cough.
4. Patient Request
Patients, like you, read health information online. Online information is great for patient empowerment, but it also increases patient requests for unnecessary tests. Many patients request specific diagnostic tests and feel worried about their own health if they don’t have the reassurance of the test result. Once you have paid your health insurance premium, you may feel that you have paid for the right to receive any test you request, regardless of cost.
While some doctors may take the time to explain why you may or may not need unnecessary tests, doctors’ concerns about being sued or provoking a negative online rating sway most to order the test (even if it is unnecessary) to satisfy the patient.
Most of the tests your doctor orders for you are done at facilities that are owned and operated by someone besides your doctor.
Most of your doctors do not earn any profits based on your medical testing. Kickbacks or commissions, where a laboratory or facility pays a doctor for referrals, are illegal in most states in the United States, although there are certainly examples of fraud.
In rare circumstances, a doctor may actually own the testing facility and may bill you or your health insurance for your medical test. This can be a motivation for some doctors to order unnecessary tests in their own facilities.
Effects of Overtesting
Overtesting costs money. The most direct effect is on your health insurer’s profits, but they generally raise premiums to make up for that. Government payers, similarly, raise taxes or cut back on other benefits to compensate for high health care costs. This means that the cost of overtesting is spread to everyone—including you.
There are a few negative effects that you can incur that are not financial, however. Having too many medical tests can provide you with a false sense of security, allowing you to believe that you are completely healthy when you really just had normal results on unnecessary tests. Another effect is that excessive radiation exposure is not considered safe, and can increase your risk of disease.
Interventional tests are all associated with the potential to cause adverse events as an effect of the test itself, and when you don’t have a strong reason to have the test, the risk is not worth the benefit.2
When Your Test Is Denied
Keep in mind that health insurance payers are strict about paying for medical services, and they require documentation justifying each and every medical test or treatment that you have. So when your doctor orders a test out of fear that you may sue or become upset, your health insurance may still deny payment on the basis that the test is not justified.
Nevertheless, it is estimated that over-testing costs the system millions of dollars annually. Even health insurance companies protect themselves against litigation by allowing costly tests that are almost certain to be of little value.
Confirm Approval of Payment Before Getting a Test
If your health insurance company denies payment for a diagnostic test, you will be billed for the service if you go ahead with the test. Most testing facilities, such as radiology facilities and laboratories, confirm insurance pre-authorization before giving you a test, but this is not always the case.
You’ll want to be sure that any test, whether or not you really need it, is pre-authorized by your health insurance payer.
When your doctor orders tests for you, there are a few things you can do to ensure that the tests are necessary. You can ask what the test is for and how the test will impact the next step in your care. Overtesting is not beneficial, and it can be harmful.
- Centers for Disease Control and Prevention. What should I know about screening?. Updated January 30, 2019.
- InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. Benefits and risks of screening tests. 2013 Nov 7.
- Carroll AE. The high costs of unnecessary care. JAMA. 2017;318(18):1748–1749. doi:10.1001/jama.2017.16193
- Greenberg J, Green JB. Over-testing: why more is not better. Am J Med. 2014;127(5):362-3.
- Hoffman JR, Carpenter CR. Guarding Against Overtesting, Overdiagnosis, and Overtreatment of Older Adults: Thinking Beyond Imaging and Injuries to Weigh Harms and Benefits. J Am Geriatr Soc. 2017 May;65(5):903-905. doi: 10.1111/jgs.14737. Epub 2017 Feb 7.
- Sikkens JJ, Beekman DG, Thijs A, Bossuyt PM, Smulders YM. How Much Overtesting Is Needed to Safely Exclude a Diagnosis? A Different Perspective on Triage Testing Using Bayes’ Theorem. PLoS One. 2016 Mar 3;11(3):e0150891. doi: 10.1371/journal.pone.0150891. eCollection 2016.