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OB/GYN Pushes Doctors To Think About Cost

Cheryl Clark, for HealthLeaders Media, August 15, 2013

In case one isn't convinced that a lot of hospital procedures have no logical rationale for a lot of order sets and procedures, some of which may even cause harm, Demosthenes has a few others that persist in her specialty of obstetrics and gynecology.

One is repeat testing in pregnant women for the inherited blood disorder sickle-cell anemia. If a woman tests negative for it one time, she doesn't need to be tested again during subsequent pregnancies. "But we just repeat the test. Why? Because it's too much effort to find the old test."

Pap smears are performed more frequently than the once-every-three year recommended interval as well, she adds. Done too frequently, they may provoke clinically irrelevant findings of things that are unlikely to be cancer, or are so very slow growing as to be meaningless. Yet pap smear tests done too frequently can lead to biopsies, which are uncomfortable, add cost, and "may lead you to have a procedure that could go wrong."

And ultrasounds, which are expensive too, are done too frequently, often in pregnant women who just want another picture, she says.

Demosthenes acknowledges a huge dilemma that doctors like her face every day. They're increasingly being scored, and paid, on the basis of patient experience scores.

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