Thus, rational use of a clinical prediction rule, rather than testing based on convention or habit, allowed for equivalent care with less testing and lower utilization of resources. Put another way, providing a valid mechanism to reach a level of diagnostic certainty can also help reduce over utilization.
Unfortunately, the promotion of rational testing may be undermined by other factors, including who owns the testing. When talk of the “profit motive” in medicine arises, it is easy to blame industry or even “corporate medicine,” but the problem may lie with us as doctors as well.
It turns out that the more equipment we own, the more we are likely to use it – a 2004 article in the Journal of the American College of Radiology estimated that self referral for imaging by non-radiologists cost the US Medicare system at least $16 billion every year (and that was 10 years ago). So, “if we own it, we will use it”—how often have you done a test “because it was there,” even though in the end it made no difference to your management? This is not to say that all self referral for in office imaging (or other investigations) is purely out of avarice or greed, but the easier a test is to obtain, the more likely we are to do it—even if, in the end, it makes no difference to our clinical decisions.
In short, it appears that the more well rounded we are, the better equipped we may be to deal with the tensions of uncertainty, possibility, and partial knowing—instead of pursuing more and more detail that may add little or no benefit to our patients’ care.
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