lack of trust in medical/dental profession

[Panscan]

Those are also super specific situations that are post op or pre op planning and not a general like ankle pain situation which is where I imagine the majority of this stuff where overimaging is being done.

[Lordosis]

Maybe it is regional but I do not order very many MRI or CT for MSK issues in primary care. X rays occasionally but I do know that ortho will repeat them a lot of the time so if I am highly suspect that the test will lead me to refer to ortho I just start with the referral.

[VagabondMD]

If most orthos started having MRs installed in their offices do we really think MR ordering for their patients wouldn’t skyrocket ? Come on

I have not read all of the responses to this. Many orthopedists own their own MRIs. In the past, I have heard some say that they earn more money on imaging than they do on operating. In more recent years, running a profitable MRI facility is more difficult than it was in the past, and I see some getting out of the imaging business. But don't kid yourself into thinking that orthopedists do not own MRIs!

[VagabondMD]

There are three universal truths that I learned in my 30 years in practice, 5 in training and 25 in private practice:

1. Unnecessary tests and procedures lead to more unnecessary tests and procedures.

2. People that would never acknowledge their own over-testing or over-intervening are very quick to point it out when someone else does it.

3. If we only did what was really necessary, they would only need about one-third of us.

[ENT Doc]

There are three universal truths that I learned in my 30 years in practice, 5 in training and 25 in private practice:

1. Unnecessary tests and procedures lead to more unnecessary tests and procedures.

2. People that would never acknowledge their own over-testing or over-intervening are very quick to point it out when someone else does it.

3. If we only did what was really necessary, they would only need about one-third of us.

What do you mean by "really necessary"?

[VagabondMD]

What do you mean by "really necessary"?

We could start with eliminating futile, end-of-life care and non-evidence based tests and interventions for the “worried well”.

[ENT Doc]

We could start with eliminating futile, end-of-life care and non-evidence based tests and interventions for the “worried well”.

That I agree with. Though I disagree that would be 2/3 of the workforce.

[Tim]

We could start with eliminating futile, end-of-life care and non-evidence based tests and interventions for the “worried well”.

Don't forget the bucket list and the End of Life Travel Wishes! https://www.medscape.com/viewarticle/916471
I mention this not in jest. When a relative wants to postpone "hospice care" to take a trip it is difficult. When a family is determined to do "everything and anything possible", it is difficult.
Even when "There is nothing more we can do." is compassionately delivered, the stories of medical travel for miracle cures (frauds) abound.

One thing the pandemic taught us is that there is no one correct answer from the practice of healthcare and medicine. Death is a tough sell, people will hear what they want to hear.

[VagabondMD]

That I agree with. Though I disagree that would be 2/3 of the workforce.

Ok, how about adding CYA testing and procedures. That should get us close.

[ENT Doc]

Ok, how about adding CYA testing and procedures. That should get us close.

Estimated to be in the neighborhood of <$100B. We spend trillions on health care.

[Kennyt7]

There is much dental care that is done and not needed as dentists are burdened with massive loans; no excuse for doing unnecessary tmt.
When you hear "deep cleaning" , be a bit suspicious especially if you have been in good oral health for a long time
The big issue is dentists wanting to replace all amalgam fillings with WHITE. DONT DO IT
I have an MD friend who told me there is much unnecessary medical surgery which really shocked me
You need an ADVOCATE when seeking med/dental care

[Kennyt7]

And Medicare is grossly overused and now the DEMS want it to pay for dental, vision, and hearing aids
Get rid of Medicare Advantage as its more costly than basic Medicare

[Kennyt7]

Yep my wife was SOLD 5500 dollar LENSES after cataract surgery. The other OPTO in town does not recommend them as there are too many complaints about them

[gap55u]

There’s a good reason for that. Have you seen the data on surgical outcomes and infections on patients with uncontrolled diabetes undergoing elective orthopedic surgery?

We routinely screened out patients when I was a resident at the VA who had uncontrolled diabetes, who hadn’t had plain films, or had no documented attempts at conservative management. Our weekly clinics were 120+ patients a day for 2 residents and 2-3 attendings, even with rigorous exclusion criteria and being on CPRS. Can you imagine seeing patients who weren’t surgical candidates beyond those kinds of numbers?

Every VA is different. They simply would not see the patient, period, if chart review said no surgery. regardless of prior management, and they were not running that kind of patient volume. Sometimes now I gotta argue the other side: few years ago, academic ortho was going to do TKR on 88 year old with a1c of 8.8,semi-demented, who won’t PT pre-surgery - helped see family that this was a recipe for heartache.

[Kennyt7]

My MD friend there is much unneeded medical surgeries. Really tough to grasp
I "NEED" possibly cardiac ablation and two EPS have somewhat different opinions as too many docs have too much "SKIN IN THE GAME"; added production, added salary
How do you TRUST what the MD says. Their income is based on doing PROCEDURES, not office visits
ANY CARDIOLOGISTS here to help me?