Unnecessary tests for 'worried well' cost thousands

Many New Zealanders are getting pointless laboratory tests to reassure them they are not getting sick - at the expense of the taxpayer.

Many patients are availing themselves of expensive lab tests every few months, as a burgeoning wellness industry profits from a growing obsession with health.

As United Future and the Greens advocate "free" annual "warrant-of-fitness" health checks for all, wellness clinics are popping up in wealthy suburbs, and GPs are starting to promote "Well Woman" and "Well Man" checks.

But it is taxpayers who foot the bill for every single laboratory test ordered, whether it is ordered by a GP, a hospital doctor or a private specialist.

GP Di Nash, who works at a practice in the wealthy Auckland suburb of Epsom, said she saw at least two or three patients a week who demanded lab tests despite having absolutely no symptoms. "Once or twice I've said no but they get very angry," she said.

Meadowbank GP and College of GPs president Jonathan Fox said some men wanted a test for prostate cancer every three months.

"It's just over the top."

A swag of lab tests to reassure patients without symptoms very seldom detect any problems in Dr Nash's experience, but can cost at least $150 - precious health dollars that could be used elsewhere, she said.

"It's a complete waste," said Dr Nash, who is also a member of the Auckland District Health Board. "There's absolutely no accountability. There's a lot of redundant, superfluous tick-the-box, do-a-batch kind of testing."

Doctors can order from a list of about 180 different laboratory tests ranging in cost from $2 to $260 each.

Last year, each GP in New Zealand ordered an average of nearly 5000 lab tests worth a total of nearly $46,000 each, according to a report that is part of a Government initiative to rationalise lab tests.

Denis Jury, ADHB chief planning and funding officer, said the three DHBs in the Auckland region alone spent about $75 million a year on laboratory tests ordered mostly by GPs and private specialists. Nearly the same again was spent on lab tests ordered by hospital clinicians.

Dr Jury did not think the "worried well" accounted for a significant portion of the lab test bill but acknowledged nobody really knew the extent of the problem.

Dr Nash said it could be difficult for doctors to turn away patients who are insisting on lab tests.

"It's easier to tick the box and send people away. And you're seen to be doing something." She said lab tests should be ordered judiciously with a particular concern in mind. A broader range of tests could be ordered to screen for potential health problems, but the effectiveness of such screening was unknown.

Professor of preventive and social medicine at Otago University, Charlotte Paul, said she was not convinced wellness checks would improve the public's health.

Lab tests in patients without symptoms created unnecessary concern among patients and diverted scarce healthcare dollars away from patients with real problems who needed treatment.

Wellness checks could include tests to check the liver, kidneys, thyroid gland, and prostate (in men), and the blood for signs of infection and for iron, sugar, cholesterol and lipid levels.

Tests

* Tests ordered by GPs and specialists in the Auckland region cost $75 million a year.
* Liver function tests: 13 per cent
* Iron levels and blood cell counts: 10 per cent
* Tests for urinary tract infections: 7 per cent
* Tests to check whether lumps and bumps are cancerous: 5 per cent
* Cholesterol and lipid level tests: 4 per cent
* Kidney function tests: 4 per cent

- HERALD ON SUNDAY