In an article called “An Egregious Example of Ordering Unnecessary Tests,” Hall describes the adventures in primary care experienced by a friend’s healthy 21-year-old son who sought a routine physical. He had no complaints, no past history of significant health problems and no family history of disease.
His doctor ordered lab tests, did not explain what they were for and the patient didn’t ask, assuming they were part of the physical. When the insurance Explanation of Benefits arrived, it showed coverage for $13.09 and said he was responsible for the remaining $3,682.98.
Here are the tests that generated that bill:
- lipids: total cholesterol, LDL-C, HDL-C, Triglycerides, Non-HDL-C
- lipoprotein particles and apolipoproteins: Apo B, LDL-P, sdLDL-C, %sdLDL-C, Apo A-1, HDL-P, HDL2-C, Apo B: aApo A-1 Ratio, Lp(a) Mass, Lp(a)-P
- inflammation/oxidation: fibrinogen, hs-CRP, Lp-PLA, myeloperoxidase
- myocardial structure/stress/function: galectin-3, NT-proBNP
- platelets: aspirinworks (urine) Ppg/mg of creatinine
- lipoprotein genetics: CYP2C19*2*3, CYP2C19*17
- coagulation genetics: factor V leiden, prothrombin mutation, MTHFR (C677T), MTHFR (A1298C)
- metabolic: 25-hydroxy-vitamin D, uric acid, TSH, homocysteine, vitamin B12
- renal: cystatin C, estimated glomerular filtration rate, serum creatinine
- electrolytes: sodium, potassium, chloride, CO2, calcium
- liver: ALT/GPT, AST/GOT, ALP, total bilirubin
- renal: creatinine, BUN
- thyroid: TSH
- others: albumin, total protein, ferritin
- omega-3 fatty acids: ALA, DPA, EPA, DHA
- omega-6 fatty acids: omega-6 total, arachidonic acid, linoleic acid
- other fatty acids: cis-monosaturated total, saturated total, trans total
You don’t have to know what all that scientific shorthand means to know it’s a lot of investigating for conditions or possibilities that a healthy young man does not present. Suffice to say the tests looked at values for heart, kidney, liver, thyroid and metabolic function in several ways.
In addition, the lab results did not include a couple of blood and diabetes tests — hemoglobin, hematocrit, blood glucose, hemoglobin A1C — but somehow still concluded:
- Glucose and hemoglobin A1c are in the normal range and are consistent with normoglycemia.
- There may be some evidence of insulin resistance. There is evidence of adipose tissue insulin resistance.
- There is evidence of hyperinsulinemia, suggesting beta cell strain. There is evidence of beta cell dysfunction. Elevated Proinsulin to C-peptide ratio has been associated with beta cell failure and beta cell dysfunction.
A routine physical on a 21-year-old male should include blood pressure, weight, updating immunizations, discussion of risk factors and counseling, if appropriate, about lifestyle issues such as safe sex, smoking, alcohol, diet and exercise.
“NO lab tests are recommended except for possibly checking lipids or HIV status,” Hall concludes, “which most guidelines do not advise in the absence of risk factors.
“I will not comment further, as I feel incapable of moderating my language.”
No wonder. (Tip of the hat to HealthNewsReview.org, which drew our attention to Hall’s story.)