Healthy Skepticism Library item: 12629

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Publication type: news

Cresswell A.
Doctors rushing patients for tests
The Australian 2008 Jan 30
http://www.theaustralian.news.com.au/story/0,25197,23130168-23289,00.html

Full text:

DOCTORS are sending their patients off for expensive tests and scans in increasing numbers as a result of rising rates of diabetes and shortages in the medical workforce.

Family doctors ordered 44per cent more pathology tests in 2006-07 than they did in 2000-01 – equivalent to an estimated 13.5 million more tests across the country.

Diabetes was the leading reason for ordering pathology tests, according to a report to be released today by the Australian Institute of Health and Welfare on GP practice patterns.

Australia is already in the grip of a diabetes epidemic. The report found pathology tests were ordered in 30.8 per cent of consultations between a GP and a patient with diabetes.

By contrast, prescribing rates fell from 93.6 per 100 consultations in
1998-99 to 83.3 per 100 in 2006-07 – suggesting there were more than 11 million fewer prescriptions given by GPs in 2006-07 than 11 years earlier.

This was partly offset by increases in the number of repeat scripts given at the original visit and an increase in the number of times GPs supplied medicines directly to patients.

The report’s authors said more analysis was being done on the “mixture of factors” pushing up test ordering.

Helena Britt, from the AIHW’s Australian General Practice Statistics and Classification Centre, said that, in addition to rising diabetes, other reasons were likely to include fear of litigation for missing a diagnosis, as well as time-poor GPs trying to give patients what they wanted.

Professor Britt said time pressures on GPs were becoming more apparent in a number of ways, including a reluctance on the part of doctors to get more involved in treating depression, despite encouragement from the federal Government.

Although programs aimed at improving diabetes care had led to more diagnoses, higher rates of referral from GPs to other doctors and health workers, and better patient management, similar initiatives in depression had had “comparatively little effect”. “They (depression
programs) haven’t really changed the situation … there was no increase in the length of consultation and no increase in diagnoses,” Professor Britt said.

The situation improved only after the introduction of a much later program, allowing GPs to refer patients to psychologists – suggesting GPs did not have the time to provide lengthy counselling sessions themselves, she said.

GPs are also being asked to write more sickness certificates – a request in 0.7 per 100 consultations in 1998-99, but which had doubled to 1.6 per 100 by 2006-07.

The difference is equivalent to a further 920,000 sickness certificates provided nationwide by GPs in 2006-07 than in 1998-99.