But I'm Feeling Better Doc!

Here's a good one. The patient was referred to a cardiologist due to chest discomfort and a stress echo was ordered which was normal without any evidence for coronary artery disease. When the patient next follows up with the cardiologist (his PA of course) he tells her that his discomfort is basically gone as his primary physican started treatment with a PPI. Rather than make the obvious assumption that the patient is being appropriately treated for dyspepsia and leave it that, they schedule the patient for a coronary CTA! Obviously if a stenosis is felt to be present, this guy will then get a diagnostic catheterization despite the fact that his symptoms have resolved with treatment for dyspepsia and he did well on his exercise stress echo with good exercise tolerance, normal LV systolic function and no evidence for ischemia. Guess who owns the CT scanner in this case? Greed on the part of the physician is another huge reason for the costs of health care. I see examples of this every day, even with my own partners. There absolutely should be appropriateness criteria and all health care providers should be forced to comply.