Why is My Hospital Bill So High? Part 2: To Test or Not to Test

When I was a resident, I was particularly lucky to have one of the best cost-control experts in the US as one of my teachers. He was amazing at keeping patient costs low by following a simple rule, “don’t order so many tests”.

For some reason, many of us in the medical field have been trained that if we order enough tests that we won’t “miss” something. In reality, this practice in more cases than not results in more problems and less answers.  A good doctor takes the time to ask the right questions so that they will be able to order the right tests and nothing else.  A confused doctor orders everything under the sun and ends up with more questions than answers.

Case in point. A few weeks ago I saw little Chastity who was brought in to the ER by her mother for a “fever that wasn’t going away”. When I entered the room, Chastity was busy playing and singing – a good sign that her fever was not much to be concerned about. Her mother though was sure that it was something serious because the fever was now in its third day. She actually came to the ER on the first day and was told that it was likely “a cold”, but this morning she was talking to a friend of hers who works in a “bigger hospital” and was told that Chastity “should have some blood tests” to make sure there was no “serious infection”.

(I’ll have to discuss the whole idea of people treating the ER like Burger King and ordering things the way they want it a bit later)

So, I was stuck in a corner. I was 100% sure that little Chastity was going to be fine but I didn’t want to deny the mother her “request” since I do put a lot of weight into mother’s intuition. If a mother really feels strongly about something for her child I really need to have a solid reason to say no. So I ordered the all-knowing blood test.

When I got the test back though, I was very surprised. Her infection profile (WBC count) was high (21k). Was the mother right after all? I explained to the mother, and the smug looking “bigger hospital” worker sitting with her, that her test was abnormally high. A high number like this in a child with fever has to have a source – ears, lungs, urine, brain, belly, etc. – or it could also mean nothing (since we don’t routinely do blood tests on happy playful children).

The next 3 hours witnessed several more tests, all of which were normal. Chastity was still playing, asking for food and in a generally good mood. I discussed the case with her pediatrician and he saw the corner I was backed into and agreed to observe her in the hospital overnight in case something was brewing. Chastity went home the next morning with no real reason as to why her WBC count was high except that she probably had “a cold”. All in all, about $10,000 in medical expenses for a cold.

And yes, I resisted the incredible urge to tell her smug hospital friend “I told you so!”

What is the moral of the story? Ordering more tests isn’t usually very helpful if you already have a good idea of what is happening based on getting a solid history and physical examination. On the other hand, ordering tests are a great way to drive people into the poor house.

Come back tomorrow to learn 5 simple things that can do to help keep costs down the next time you have to go to the hospital!

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5 Responses to Why is My Hospital Bill So High? Part 2: To Test or Not to Test

  1. TUNDE says:

    wow, yes us mothers sometimes get too worried, especially when someone starts telling us ..”it might be serious, or so and so’s kids had this symptoms and needed hospitalization etc. ”

    I was one of those mothers who took the kids to the doctor every time they caughed or had low grade fever. Now , i look first and wait a little to observe.

    Although, recently i had a very terrifiying experience with my son, and that put me right back where i was years ago. Mother’s intuition you must listen to (well as long as the mother doesn’t have any psychiatric issues), when my son had his episode (that is how i call it, since they still don’t have a clue why he stopped breathing) in the beggining i knew in my heart something is majorly wrong… and within minutes unfortunately it was comfirmed, but i acted quckly and help arrived very soon.

    I think most of the doctors order a bunch of tests not just b/c they are trying to find what is really wrong, they are trying to cover every aspect so they do not get sued…. yes it comes done to money again, and career. They go to school, and suffer through internship, residency, sleepless nights never ending, and one patient who is not really pleased with the care, or just too sick will end their career.

    Others …maybe they just don’t have the experience yet to be confident about making decisions based on only a few tests. take your pick.
    Health care is becoming “SCARE CARE” unfortunately, and it hurts medical professionals and patients as well. It is time for change. how i have no clue.

    • ER Doc says:

      You are so right and I like that phase “scare care” – the solution really involves all of us changing the way we approach medical care and I am not sure how we can do that either. Maybe Oprah needs to get workin on this right? lol

  2. Sabra says:

    I always wonder about these mothers. The last damn thing I want is my kid poked by a needle & caused pain that I am not 100% sure is necessary. A close runner-up to that is how little I want my kid to spend the night in the hospital, especially considering that I’ve got two other kids to take care of at home, and school, and one nursling. I’d feel compelled to camp out at the bedside of any child of mine who was in the hospital, and really don’t we want to avoid that sort of thing?

    • ER Doc says:

      I totally agree Sabra. We all wonder about those parents that want their kids to go through painful tests “just to be sure”. It can be frustrating when someone comes to the ER looking for a medical opinion but then totally disregards what we have to say.

  3. ndenunz says:

    Unfortuantely, the smug friend was probably thinking “I told you so” when the child got admitted for the night. So, I don’t think any behavior was changed.

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