The appearance of three articles in the Star-Advertiser recently spoke to different areas of the very complex arena of health care.

First, there was emphasis on harm to patients and physicians due to delay and second-guessing by HMSA (or any other insurance company) in its review of a physician’s orders involving imaging studies such as MRIs (magnetic resonance imaging and CT (computerized tomography) scans.

The presumption here was that the physician always knows best (“Not what the doctor ordered,” Jan. 24).

Unfortunately, this is frequently not the case.

As an example, taking HMSA’s former waiver policy championed by Dr. Christopher Marsh, one must ask why some physicians were granted waivers and others not.

It implies that HMSA believes that non-waived doctors don’t know what they’re doing and need preauthorization.

How large is this group?

Obviously, HMSA feels it is larger than it used to be, so it removed waivers for a group it previously trusted and opened up all doctors to preauthorization — thus opening the possibility of enlarging the non-waived group to save money.

The American Board of Internal Medicine Foundation in 2012 initiated its “Choosing Wisely” program, which promotes doing what is appropriate for the patient.

This was alluded to in the second article, by HMSA’s chief medical officer, Dr. Mark Mugiishi (“Preauthorization protects health, safety of HMSA members,” Jan. 28).

“Every dollar spent on unneeded services means a dollar less for someone to spend on essentials such as necessary health care, housing or education,” Mugiishi said.

“Even imaging services without radiation can be overused, leading to ‘false positive’ findings that begin another round of unneeded and often invasive testing that creates risk … without necessarily providing benefit.”

The gist of those comments, that unnecessary tests can cause harm, and by avoiding them, the dollar saved can be allocated more usefully, are both worthy goals — but not quite central to the true goal of appropriate treatment.

The third piece — a Jan. 29 editorial titled “Restore HMSA Waivers ASAP” — backs the initial article’s contention of delays and red tape. Nothing is said about whether this harms patients or is beneficial, whether the administrative costs of preauthorization red tape hinders or improves patient care and safety.

There is another avenue of thought or attack for this challenge that has not been broached in this discussion, which has generated much energy resulting in heat but little illumination. It is the answer to “What is best for the patient?”

Under the auspices of “Choosing Wisely,” nine medical specialty societies, including the American College of Radiology (ACR), were requested to choose five tests within their purview they believed were overused. Of the 45 services listed, 24 were directly related to diagnostic imaging.

The implication is that a panel of medical experts, including radiologists, believes that many doctors do not choose wisely, i.e., for the patient’s benefit.

The thrust of this commentary is about outcomes from appropriate patient care — not just money, prerogative, safety, convenience or red tape — but effective appropriate care.