Medical tests: Less may be more


David Sedaris is the deadpan pipsqueak Will Rogers for our times, zeroing in on peculiarly American attitudes while simultaneously exploding them. He's championed mostly by urbanites, but reading him is vaguely horrifying, like discovering termites have infested your most comfortable piece of furniture. If you're in a flyover state, Sedaris doesn't exist at all--though you'd probably beat him up if he did.

Not surprisingly, Sedaris has been living in France the past several years. Yet he has recently published a most eye-opening essay about the American expectations of healthcare.

In this essay Sedaris discusses his Parisian physician, Dr. Médioni. He charges about $50 for either a house call or office visit. Médioni answers the phone at his practice. He seems like a dream doctor, except he's learned his bedside manner at the feet of Albert Camus.

Sedaris makes an emergency appointment when he finds a lump in his rib cage.

"Oh, that's nothing," the doctor declares without performing a single test. "A little fatty tumor. Dogs get them all the time."

Asked if it would grow, the doctor replied, "Sure, probably." Pressed on the how or why, he says wearily, "I don't know. Why don't trees touch the sky?"

This makes Sedaris a little suspicious. "Maybe, being American, I want bigger names for things," he wrote. "I also expect a bit more gravity. 'I've run some tests,' I'd like to hear, 'and discovered that what you have is called a bilateral ganglial abasement, or, in layman's terms, a cartoidal rupture of the venal septrumus. Dogs get these things all the time, and most often they die. That's why I'd like us to proceed with the utmost caution.'"

He's much more comfortable with his French periodontist and dentist, who have yanked four teeth to date and perform intensely painful deep cleanings twice a year.

Had Sedaris been more policy wonk than humorist, he would be denounced for embracing socialized medicine. The TSA would be pressured to confiscate his molars the next time he re-enters the United States. A campaign would be launched to rename our stray lumps of adipose Liberty Tumors.

Nevertheless, Sedaris' expectations have just been simultaneously reaffirmed and repudiated by some of the biggest medical societies in his homeland. Last week, a group of nine medical societies led by an affiliate of the American Board of Internal Medicine produced a list of the 45 most overused tests and examinations in the United States. They include electrocardiograms for annual physicals, pap smears for adolescents and antibiotics for sinus infections. Twelve consumer organizations, including the venerable publication Consumer Reports, threw their support behind the reduction of such testing.

Consumer Reports has its reasons for why it's lending such support: In 2010 it surveyed 1,200 perfectly healthy adults between the ages of 40 and 60 and found 44 percent of them had undergone an unnecessary cardiac stress test.

The medical societies believe as much as 30 percent of American healthcare delivery is wasted on duplicative tests. That would represent as much as $600 billion a year, although most experts believe the figure is closer to $200 billion.

That can't be heartening news to hospitals, where much of the most comprehensive--and priciest--testing takes place. Any facility trying to make the lease payments on a $2 million MRI suite knows what I am talking about.

Yet even the $200 billion savings would be more than enough to provide some form of coverage to the 50 million Americans who may have questions about their health but no insurance to get them into their doctor's front door. And hospitals would have to perform far fewer tests on the uninsured who wind up in their emergency rooms anyway because they have nowhere else to go.

For all his droll grossness, Sedaris has hit on something fundamentally important: Fewer x-rays and more existentialism might add up to something. Maybe it could help our overfed healthcare system one day reach the sky. - Ron (@FierceHealth)

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