Anonymous physician submission

This is a series of case that highlight how midlevels can overall increase the cost to the medical system.

I work in a large academic center where midlevels are the predominate primary care "provider". I get several orders for EMG/NCS (a test of the muscles and nerves). On one particular day, three of the five orders were from nurse practitioners. All three midlevel cases were completely unnecessary tests.

Case 1: 30-ish year old referred for weakness and distal paresthesias. EMG/NCS study was normal as was the neurological exam done at that time. Actual diagnosis: pain-related give-away weakness and deconditioning.

Case 2: 50 year old referred for "bilateral carpal tunnel syndrome". EMG/NCS study was normal. Actual diagnosis: trigger finger.

Case 3: 60 year old referred for "right leg neuropathy". EMG/NCS study was normal. Actual diagnosis: lateral femoral cutaneous syndrome (which is a benign clinical diagnosis and does not need EMG/NCS).

In all three cases, the ordered procedure was not reviewed by a physician and was an unnecessary test and a waste of medical resources and time. Case 2 and 3 were the most egregious and any third-year medical student would know how to obtain a diagnosis for these benign conditions and avoid over-testing.