Women who have prenatal care have these tests usually done in early or mid pregnancy. Obstetricians, whether at our clinic or in private practice, are supposed to send these results to the Labor and Delivery area of our hospital when the mother is about 34 weeks along, so we will have them when the mother comes in to deliver. This is a common arrangement, but at our hospital obstetricians only do this in about 60% of pregnancies. For some obstetricians the percentage is much lower. There is no good reason why some of them don't send them in; rather, it usually occurs because of laziness or inefficiency on the part of the obstetrician or his or her staff. When the results have not been forwarded to the hospital, the labs are drawn again when the woman is admitted in labor. Tests, sometimes expensive ones, are repeated. It might not seem like a large amount of money per patient, but when you multiply the cost per patient by several hundred - the number of times per year we need to duplicate tests unnecessarily - it adds up to a significant chunk of change.
I write this post in response to Dr. Rangel's request for ideas about what's wrong with the U.S healthcare system for this week's Grand Rounds. I'm sure there will be many fine posts about things like malpractice and tort reform, access issues, payor and insurance reform, or simply about getting rid of as many administrative layers as possible. But too often we doctors are unwilling to look at ourselves and at what we can do right now to improve healthcare. I'm not saying that improving the rate at which OB's send in their prenatal labs is a huge thing, but I bet that in every specialty other doctors could come up with similar examples of wasted or duplicate tests, wasted simply because we are unwilling to make our offices or clinics as efficient as they could be. There are other examples of waste due to our own laziness, too. I hear internists in our hospital complaining that they have to keep patients in the hospital an extra day because an X-ray result is not back yet. It's not back yet? Well, then go down to radiology and find the film and a radiologist to read it. And the lax job we physicians do in getting rid of bad doctors is a whole other topic.
There are lots of people we can blame for problems in healthcare, but physician friends, we have to fix our own problems before we can expect others to fix theirs. And by the way, although I recognize there are many problems with U.S. healthcare, I still think it's the best in the world.
P.S. A new Pediatric Grand Rounds is up.