B12.

Sounds simple, huh?

1 letter, 2 numbers. One of the B vitamins. It’s important in a number of body functions, particularly the nervous system and blood cell production. It’s in pretty much all meats and vegetables, and multivitamins you can buy.

To me, it’s also a good example of what’s wrong in health care.

Let’s take Mrs. Olde.

She goes to her internist, and is complaining of feeling weak and tired. So he checks a B12 level, thyroid labs, and other stuff.

A week later, she’s out with some friends, and trips in a movie theater. She breaks her leg, and lands in ER. She gets admitted to the hospital.

There she mentions that she feels weak and tired to the admitting hospitalist. So, with the usual pre-surgical labs, she checks a B12 level, thyroid labs, and other stuff.

She does fine in surgery, but afterwards has a mild anemia, which doesn’t improve. So after she gets out of the hospital she goes to a hematologist. This doctor doesn’t have any of the previous tests, and so orders another B12 as part of the work-up.

While she’s recovering, she’s taking Percocet for her broken leg. She mentions to her daughter that her memory is foggy, and so the daughter takes her to see a neurologist.

The patient comes to the neurologist. He thinks the problem is due to Percocet, but to cover himself he orders a head CT. Since he doesn’t have access to her hospital records, and she doesn’t have any of her previous labs with her, he orders a bunch of blood work, including a B12, thyroid labs, and other stuff.

Story over.

Now, a B12 level, according to Local Lab, costs $198. So this lady has had 4 done, for a total of $792, in less than a month. B12 levels generally don’t change that dramatically in a month, so only 1 was really needed (yes, I know some of you are thinking a methylmalonic acid level is more useful than a B12, and I agree with you. But that’s not the point here. And try getting Medicare to pay for an outpatient methylmalonic acid).

$198 isn’t that much, is it? But multiply it by thousands of patients a month with similar stories. That’s a huge amount of money wasted. And then extrapolate it to many other redundant tests: CBCs, TSH, chest X-rays. And then add pricier items (though not as commonly reduplicated) like CTs and MRIs.

I generally don’t order labs if I know a patient has recently had them. I try to get the old records, then order anything I need that hasn’t already been done. But many docs don’t do that. And sometimes the patients are less than helpful. They forgot they had stuff done 2 weeks ago. Or don’t remember the name of the doctor/hospital who did them, making it impossible for me to track them down (you’d be amazed how many times people have no idea what hospital they were in recently, or what doctor ordered their tests).

I’m guilty of this myself. Yesterday I admitted a guy to the hospital, who told me his outpatient work-up hadn’t included any labs. So I ordered a bunch. This morning I came into my office to find everything I had done last night was also done 3 days ago, and was sitting on my fax machine. According to the hospital labs, the total cost on these duplicated labs was $1278.

I don’t think the patent did this intentionally. He’d either forgotten, or (and this is common, believe it or not) thought that the labs his internist ordered wouldn’t be ones a neurologist would want, and therefore didn’t count.

Redundant tests, I think, are a huge waste of money. I’m not sure what the answer is here.

Some would say we need to have all these records in a huge database, searchable from anywhere, and protected by elaborate security checks. This would likely be the best answer, but I think all of us have huge concerns about the security and privacy issues involved.

Better communication between doctors would help. You have no idea how much I appreciate it when a referring doctor sends labs and test results in advance, or even with the patient. That way we all save time, money, and blood on further tests.

Another option is to put the patient in charge of their records. Some are good at this, bringing copies of labs going back to their childhood. But most don’t. Giving them a memory stick or CD with past tests sounds good, but those things can be forgotten. Or lost. Or not work on a different type of computer.

I don’t have an answer for this. I wish I did. A good solution on a large scale would likely save a huge amount of time, money, and aggravation for all of us.

Doctor Grumpy is a neurologist who blogs at Doctor Grumpy in the House.

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