A profit-driven health care system has to do what all good businesses do–make money. One way is to stay away from time-consuming, low tech services and instead market popular high-tech services. There’s also liability. No doctor gets sued for ordering too many tests.

This doctor tries to explain to patients that they don’t need an MRI…

Frank is a fit, 59-year-old insurance adjuster who had felt the pop during a kickboxing class 10 days before. He immediately had a pretty good idea of what had happened, so after limping out of the gym, he called an old friend who is a retired orthopedist. “He said he was pretty sure it was my Achilles, but I wanted an MRI to be sure. He just said ‘fine’ and gave me the prescription.” I spoke with Frank and showed him the powerlessness of his ankle – the squeeze test. I even had him put his finger into the divot in his tendon. I tried to be gentle about bringing up the s word – surgery – but when I finally broached it, he shot back with, “But you haven’t even looked at the MRI yet. I heard the ads – it’s the new stand-up unit. Listen, doc, I know you’ve treated this before but …” So I just put up the films and showed him the tear. I could have been showing him a plate of scrambled eggs, but he was happy and we booked his case.

A couple of years ago there were ads for full-body scans for a few hundred dollars. Patients were asking me about it. I told them that they should ask their doctors what tests they really needed, and likely their insurance would pay. I do elder care, and most of my patients are on a fixed income and don’t have a few hundred dollars lying around.

My dentist sent me to an endodontist to see about a root canal. The endodontist tapped my tooth a couple of places and told me I didn’t need one. Even though I had to pay out of pocket, (my insurance would have covered the procedure) I left happy and pleased that the doctor gave me such good care. She could have made more money giving me something I didn’t need.

Dr. Atul Gawande visited McAllen, Texas, where the health care costs are high and the quality is nothing special. Time is money, it’s true. But more time for doctors and nurses to spend with patients would do more across the board than another expensive test.