Are those expensive medical tests really required?

Doctors can order a wide variety of tests today and sadly many patients naively that the more expensive tests are better. After all, the fact that they cost more money means they must be more highly s

By: Dr Aniruddha Malpani | | Updated: April 21, 2014 1:00 pm

Doctors can order a wide variety of tests today and sadly many patients naively that the more expensive tests are better. After all, the fact that they cost more money means they must be more highly sophisticated, and will provide more information. Also Read - Most medical tests for women under 21 years unnecessary

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Unfortunately, this is a myth , which is driven partly because of the consumer driven society in which we live . Thus, if a bottle of ordinary wine costs Rs 500; and a vintage year costs Rs 5000, then it stands to reason that things which are more expensive are of greater value . This message has been drilled into our heads as a result of modern marketing and advertising, and doctors also do their best to persuade us that this is true . After all, isn’t the quality of the images provided by a more expensive 32 slice MRI scanner better than a 16-slice scanner? Isn’t it worth paying for quality, especially when it involves something so important as your health? Also Read - SLIM -- an organisation committed to doing away with unnecessary medical tests

In reality, the opposite is true! Let me explain. Newly introduced medical tests tend to be expensive. This is because they are based on expensive R&D, and companies need to recoup their investment. Because it’s a new test, they have a first mover advantage, and can pretty much charge as much as the market will bear. They simply need to convince the doctor that the information they provide is useful and cost effective.

Since we live in a competitive capitalistic society, if the test is truly valuable, then a lot of other manufacturers will start offering less expensive alternatives to the test. This competition will cause the test to become more affordable and more easily available. However, if it is not a useful test, then no one else will bother to offer it, simple because it has limited utility in a limited market . As a result , only as few doctors will continue to order the test, and because the monopoly situation is likely to persist, the test will continue to remain expensive . However, remember that because something is expensive does not make it better.

In fact, in medicine, it’s the opposite which is true. Because the test remains expensive, few doctors will bother to order it. This means that the real-world clinical experience with this test is likely to be limited (for example, NK cell testing or ERA testing), because its value is unproven. Because it is ordered infrequently, doctors are never going to be able to get enough experience with it, because it will never become widely used.

On the hand, tests which have prove to be of clinical benefit become inexpensive because of competition. They provide useful information, and their utility increases over time, because they are ordered commonly, and as doctors accumulate more experience with the results, they understand the specificity and sensitivity of these tests better, so that they can use these test results to generate clinically actionable decisions.

The author Dr Aniruddha Malpani is an IVF specialist who is also very passionate about improving patient knowledge and patient-doctor relationships. He is a pioneer in the field of information therapy the right information at the right time for the right person and blogs at http://blog.drmalpani.com.

Also read Dr Malpani’s other articles on doctor-patient relationships, patient advocacy and healthcare:

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Published : March 19, 2014 12:22 pm | Updated:April 21, 2014 1:00 pm

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