Cost of health care in the U.S.

What's driving up the cost of healthcare in the U.S.? We are. There is a tremendous amount of excess being performed in hospitals due to lack of thinking and diagnostic skills with heavy reliance upon objective testing and fear of litigation. Example: a 57 year old gentlemen with treated diabetes and HTN presented to our emergency department with the complaint of chestpain that had been persistent for > 12 hours. The pain was positional, worsened with a deep breath and he was very tender to palpation over the left anterior ribs. He was monitored in the chestpain unit overnight, serial biomarkers were drawn and normal, ECG was normal, Chest xray and a chest CT were performed and unremarkable. NTG was given without a response. Even with a diagnosis of "musculoskeltal" chest wall pain, I was called to come in and do a formal cardiovascular assessment on the patient before he was discharged. There was some surprise when I decided against any objective evaluation for coronary artery disease. In my day, the history and physical along with simple testing like ECG was enough to triage people in the acute setting. Every patient with chest discomfort does not need a CT scan, and myocardial perfusion study. You have to wonder if the excess radiation exposure from some of these studies might not have something to do with the incidence of soft tissue malignancies like breast CA in the population.