It's often said "life is a test" that reveals how a person reacts to the various situations they encounter. That view holds that our character and convictions are being tested constantly by the trials and tribulations in our daily lives.
In this light, we're also offered ongoing opportunities for personal and spiritual growth. Therefore, for many adherents of this perspective, understanding life as one long test also means that nothing in one's life is insignificant.
I was thinking about this philosophical sensibility while reading the results of a new nationwide survey that explored the views of 600 doctors on ordering tests and procedures for patients.
Released May 1 by the ABIM Foundation, they seem to suggest that life as a patient may also entail being tested a lot -- but often with medical tests and procedures that are insignificant to their health.
The survey revealed nearly three-quarters of physicians considered unnecessary medical tests and procedures to be a "serious problem" within the U.S. health system. And more than 70 percent of them also said "the average physician" prescribed such unnecessary interventions at least once a week.
These unsettling assertions raise obvious questions about the complicity of us doctors in sustaining a "serious problem" of our own making. After all, we're ultimately responsible for prescribing most of those tests and procedures.
Concern about unnecessary testing has focused primarily upon the considerable financial burden it imposes on the U.S. health system. An Institute of Medicine panel recently estimated the annual price tag for providing unnecessary services, including tests, at a whopping $210 billion.
More recently, we've also witnessed an expanding focus on the human toll exacted by unnecessary medical testing. Clearly, the more you unnecessarily test and scan a human being, the more likely you are to find "something" that, in turn, leads to more tests and procedures in pursuit of diagnostic clarity.
The term "investigation momentum" has been coined to describe the additional, and potentially excessive, testing that often follows from the psychological uncertainty experienced over inconclusive or ambiguous test results.
A patient can become a victim of too much medicine, trapped in a testing spiral that feeds exclusively on further testing. And, in the sometimes dubious end, it's the patient who bears the unnecessary risks of the biopsies, the radiation exposure from the scans, the lost time for blood draws and clinic visits, and the anxiety of having "something" that seems to demand so much medical attention and costly intervention.
And yet, according to the surveyed physicians' views, patients seem to request unnecessary tests or procedures with disconcerting frequency: 47 percent of doctors claimed to field such a request in their own practice at least once a week and 30 percent did so "several times" each week.
Furthermore, when presented with the hypothetical situation of a patient insisting on getting unnecessary testing, the majority of physicians (53 percent) conceded they would ultimately order the test.
This brings me back to the beginning of this column, wondering about life as a test and trying now to understand how that sensibility might apply to a professional life. In other words, when conceptualizing a doctor's professional life as a test, what's being revealed when a physician reacts to workday challenges by choosing to prescribe needless, and potentially harmful, tests to patients?
How do self-reflecting physicians judge themselves when enacting behaviors that clash with their profession's core values?
While the current survey doesn't address these questions, I believe many physicians are struggling mightily with difficult answers to them.
That physicians may feel anxious about their situation is, however, suggested by the answers they offered when asked why so much unnecessary testing was being ordered.
Their top-cited reasons included "concern about malpractice issues" (52 percent); "just to be safe" (36 percent); and, "wanting more information for reassurance" (30 percent).
We've been long aware of the onerous cost of defensive medicine, in which health care providers order unnecessary tests or procedures to guard against perceived liability in malpractice lawsuits.
For example, a 2010 Health Affairs study estimated defensive medicine to cost $45.6 billion in 2008 alone. But on a deeper level of accounting, it's ethically troubling that so many of us seem to be treating our own anxieties by "testing our patients" at their expense.
Clearly, the problem of unnecessary medical tests is about more than money, requiring more than a calculator and accountant for resolution. And clearly, any solution will require deeper understanding and formal ownership of the problem.
Unfortunately, it's been hard for doctors and patients to have rational conversations about limiting unnecessary medical testing. Beyond the fundamental problem of no bright line existing that reliably separates "necessary" from "unnecessary," we're inundated by loud, fear-mongering political rhetoric over health care that makes it difficult to hear one another.
And yet, some notable efforts are under way. For example, the ABIM Foundation, who sponsored the current survey, has launched an initiative called Choosing Wisely to "encourage physicians and patients to think and talk about whether certain medical tests and procedures are really necessary for their condition."
In partnership, Consumer Reports is communicating that information to the public.
Meanwhile, as doctors and patients together, we're all being tested by the problem of unnecessary medical testing.
Kate Scannell is a Bay Area physician and the author of "Death of the Good Doctor."