Introduction

Reviews

Should You Have Tests Performed in the Doctor's Office?

Timothy B. McCall, M.D.

Once a doctor makes an investment in medical equipment, there is a natural tendency to use it. Doctors in private practice commonly purchase testing equipment for their offices such as blood analyzers, X-ray machines, EKG machines or more fancy heart monitoring equipment. Roughly one quarter of all lab tests are performed in doctor’s offices. Approximately 75 percent of all X-rays taken outside of the hospital are performed in the offices of doctors who are not radiologists.

My medical junk mail (about five times the volume I get at home) regularly contains advertisements for various office testing equipment. Prominently featured on many of the brochures are words like “Income Potential.” Here’s a typical blurb: “It takes only a few tests a month to recoup the cost of an IMEXLAB 9000. Most physicians perform many more and because tests are reimbursed by Medicare and by third parties, each one builds profits!”

A the New England Journal of Medicine study compared the frequency of X-rays ordered by doctors who had X-ray machines in their office with those who had to refer their patients to another facility for the tests. It found that doctors who performed X-rays in their own offices ordered them more than four times as often and consistently charged higher fees. An ultrasound on a pregnant woman performed in a doctor’s office, for example, averaged more than $300. The same test done by an X-ray specialist, a radiologist, averaged $185.

The quality of tests done in doctors’ offices is often not good. X-rays done in doctor’s offices may not only be done to excess, they may not be as safe or as accurate as those done by radiologists. Office doctors often train their receptionists or secretaries to take the X-rays. Unfortunately, neither the doctors or their staffs may fully appreciate the dangers of radiation or apply adequate safeguards against excessive exposure. Because they don’t understand the equipment as well, they tend to deliver more radiation than necessary per film, to take more films than necessary and to repeat more X-rays due to poor technique.

Until recently, office labs weren’t regulated by the federal government or by most states. As is the case with X-rays, the tests are often done by nurses or billing clerks who have no formal training in laboratory technology and the accuracy of the results is questionable.

For example, the College of American Pathologists studied the proficiency of 5000 labs across the country by sending them a blood sample with a known level of cholesterol. A lab was judged acceptable if its results were less than 5 percent off. Almost 90 percent of commercial and hospital labs met the standard of quality. Less than 30 percent of the labs in doctor’s offices did so. Almost one third of doctor’s labs were more than 15 percent off, more than 3 times the acceptable level. The key factor that predicted accuracy was the skill of the operator and in doctor’s offices they weren’t as reliable.

In general, the more tests a doctor’s lab does, the better the accuracy. Doctors’ labs vary in how busy they are. A lab in a large group practice probably performs many more tests per week than a similar lab in the office of a solo practitioner. Hospital and commercial labs that run hundreds of tests per day tend to be the most proficient.

Tests in the doctor’s office are, of course, not necessarily inappropriate. You simply need to be aware of how the profit motive can affect a doctor’s recommendations about which and how many tests you need. Because of accuracy problems in doctor’s labs, you may be more inclined to repeat surprising test results, possibly at a commercial or hospital lab.

As the government increases its scrutiny on doctors’ labs, the quality should improve, although these labs probably won’t, anytime soon, reach the level of accuracy of labs with certified laboratory technicians. At times, the convenience and timely availability of test results in the doctor’s office may be worth the added expense and the risk of inaccurate results. At times, they may not.

Next: The Connection Between Emotions, Health and Disease

Return to Examining Your Doctor