New Jersey Doctor Forced to Retire: He Didn't Order Enough Tests

Recently, I gave a lecture for medical grand rounds at St. Peter's University Hospital in New Brunswick, NJ.  It's on C-Span's video library (http://www.c-spanvideo.org/program/294998-1).  Afterwards, I received a letter from a physician who was in the audience.  I called to thank him for the letter and he allowed me to quote him for this blog. I'll call him Dr. G.

This Ivy League educated ophthalmologist wrote with concern about the health care systen being "awash" in money. "I think the addition of multiple useless tests has increased the cost and harm to patients.  I can't say enough about this," he wrote.  "We have known about these things in our profession for a very long time, yet nothing seems to be done about it." 

Dr. G. mentioned a good friend of his, a cardiologist, who was "nudged into retirement because he didn't order enough tests on the equipment which his practice had purchased.... His loss is immeasurable; he was able to substitute good clinical judgment for a bevy of tests."

Dr. G. seems to be a very conscientious physician.  He has had 4 major illneses and believes that experience is "the most valuable part of my training since it taught me the value of being a patient and the tremendous influence a doctors has over the course of an illness." 

The good doctors are still out there.  But I worry about them.  I also worry about the patients of the doctors who drive out the good ones that practice medicine for the right reasons.

One of those patients was a colleague of mine, a scientist and researcher.  She has had a heart murmur for years and closely monitored her condition.  As part of her watchful approach, she went to a diagnostic testing center, which happened to also be in New Jersey, and had a stress test.  When the test was completed, a young cardiologist said she needed to stop jogging right away, that she needed to be on a prescription drug, and she needed mitral valve surgery, an open-heart procedure. 

My friend, the scientist, was devastated.   She talked about a family friend who had recently died on the operating room table during open heart surgery at a Philadelphia hospital.  Her doctor's recommendation for open heart surgery compelled the wife and mother of two children to contemplate her own mortality.

"You won't believe this," she said as she continued telling her story.  She said that while she was on the treadmill, she overheard the doctor tell the nurse, "We're at 9 patients a day; we need to get to 14 so this place pays for itself."  At that moment, she knew she wouldn't trust anything the doctor recommended.  In fact, he wanted to do a cardiac catheterization right then.  She had the wisdom to leave that place and never look back.  She found a team of physicians who concluded that she should maintain watchful waiting.  Three years later, she is doing well. 

Dr. G. ended his letter this way, "Most of the people who come to see me want a good night's sleep or they want direct, honest, efficient care with a minimum of fuss."  I think he's right.: