TEST STUDENTS, NOT PATIENTS:

Financial reasons aside, there are other reasons to end this practice as well. Here are two of the biggest.

The first is based on the idea that we don't always know what works. H. Gilbert Welch referenced this when he wrote about two of the more prevalent methods of cancer screening ‒ the PSA test for prostate cancer and mammography's for breast cancer.

How would you have felt ‒ after over a decade of following your doctor's advice ‒ to learn that high-quality randomized trials of these standard practices had only just been completed? And that they showed that both did more harm than good? Justifiably furious, I'd say. Because these practices affected millions of Americans, they are locked in a tight competition for the greatest medical error on record. The problem goes far beyond these two. The truth is that for a large part of medical practice, we don't know what works. But we pay for it anyway. Testing What We Think We Know ‒ H. Gilbert Welch, MD and professor of medicine at the Dartmouth Institute for Health Policy and Clinical Practice

Those last two sentences are worth repeating. "The truth is that for a large part of medical practice, we don't know what works. But we pay for it anyway."

The second argument against self‒referrals is a variation in medical mistakes called the silent misdiagnosis. Obviously a misdiagnosis can be direct and overt (affecting as many as 12 million Americans each year), but often it's more subtle and favors the clinical over the patient preference. This is referred to as a silent misdiagnosis and was summarized in this article in the U.K. for The Kings Fund (2012).

For example, doctors believe that 71 per cent of patients with breast cancer rate keeping their breast as a top priority. But what is the actual figure reported by patients? 7%. Furthermore, doctors believe that 96% of breast cancer patients considering chemotherapy rate living as long as possible a top priority. But what is the actual figure reported by patients? 59%. Patient's Preferences Matter ‒ Stop The Silent Misdiagnosis, by Al Mulley ‒ MD, Glyn Elwyn ‒ MD and Chris Trimble

Both of these reasons speak directly to the general practice of all referrals, so the issue is much larger than just a financial one ‒ often it's simply the authoritative (and wrong) clinical preference.

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