The President recently had his annual physical exam. His Doctor, Jeffrey Kuhlman, is setting the standard for defensive medicine. His only patient, a healthy 48 year old man, was subjected to whole body electron beam tomography and a virtual colonoscopy. The former has no accepted medical use which is why Medicare and commercial insurance don’t pay for it. The latter also is not indicated for a 48 year old man with no GI complaints. The President also had a PSA.

Dr Kuhlman’s diagnostic onslaught is not for fear of suit, but rather for fear of missing something, no matter how remote, in his highest profile patient. It’s instructive that the President had a test that government health insurance won’t pay for. Equally informative is that this test costs only $100 precisely because the patient has to pay for it himself. AN EBT is of similar technological sophistication as an MRI or CT which costs about 40 times as much. These imaging tests, of course, are paid for by Medicare and commercial insurance. The whole story abounds in irony and instruction. Do your own analysis.

I won’t touch on the issue of the routine physical exam except to say that its has repeatedly been shown to be of no preventative value.

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