Screen me or I'll sue

So, I saw a woman in her 40′s this morning who demanded to be screened for ovarian cancer. Knowing that no governing body recommends this, I had a long discussion regarding the risks and benefits of screening for ovarian cancer. Then came the line: “It is my right to demand this test, if you won’t, I’ll sue the clinic”. Nice. Thoughts of this story came into my head.

To make a long story short, I ended up ordering the CA-125 and the transvaginal ultrasound. Defensive medicine at its best.

Comments

Bard-Parker
I hope you fired her. Such threats do nothing to improve the patient-physician relationship.
Anonymous
I agree. This is extortion that has been used to undermine your professional judgment. Patients who make threats of any kind should be discharged as soon as possible, with the appropriate short-term emergency provision for coverage and referral to a local physician referral service. (If you haven’t had to do this before, most malpractice insurers have model letters to accomplish this end.)
It is a shame. People say things they shouldn’t and for that there are consequences. You would think someone her age would know better.
Anonymous
In PA, there is legislation proposed to prevent doctors from discriminating against lawyers as patients. You could not refuse a malpractice lawyer service as a doctor. Being a lawyer would join the other privileged classes, with special rights enforced by the jackbooted, automatic weapons totting thugs from the DOJ. So, it is possible that even a criticism of the legal system to this patient may get construed as harassment and a violation of discrimination laws.
Let’s make an analogy. A Holocaust survivor is a grocer. A member of the Nazi Party enters his store. He is young, had no direct involvement with the Holocaust, but spouts Nazi beliefs. This survivor continues to dream of his assassinated family nightly and remains traumatized.
Should he be forced to serve this Nazi, under pain of investigation for harassment and discrimination? Should he then be sued for denying this group member service? Should he be subject to injunctive constraint under the Civil Right Act of 1964?
Doctors are the Jews. Lawyers are the Nazis in this scenario, in case any lawyer gets confused.
HELENKRAUSMDSC
The appropriate response should be “Ms. Smith, it is your right to request the test. But understand, your insurance probably will not pay for it.” I wonder if she would be willing to pay out of pocket for tests.
ReploglePlasticSurgery
HelenKrausMDSC has it correct. If after the long discussion regarding the risks and benefits of screening you told her how much the test costs and she would have to pay for it in advance, you wouldn’t have much of a problem. As for the threat of a lawsuit, the patient’s care isn’t acute or even medically necessary. I would inform her that you are not able to provide care for her. No need to say, “go ahead and sue”. Just tell her she’ll have to go to someone else who might agree with her. I do it in plastic surgery all the time.
Anonymous
I might have an explanation for this woman’s behavior. I believe it was on MSN health’s website last month where they were discussing what you should expect from your doctor. It advised people to demand tests even if a physician saw no reason to do so, and if the doctor still refused, to demand a note be put in the patient’s file noting the doctor’s so-called negligence. I wish I had kept the article, because it basically encourages patients to bully doctors as well as regard them like a sales clerk rather than a trained professional. The nerve of some people, if only litigious behavior caused a terminal disease maybe we’d all be better off. I am a college student who dropped my pre-med major because I dread having to deal with some of the malpractice nightmares I read about.
ReploglePlasticSurgery
Amazing.
I just finished writing in the comments about the PSA screening malpractice case and returned to the main comments. I was writing something about how our best and brightest are no longer going to medical school…
Anonymous
This is a problem that’s going to continue. I also seen that article another poster mentioned about demanding tests from your physician. There are message and support boards all over the web that advocate that very thing. If someone has a 1 day stomachache and comes online to seek advise from a support board, 4-5 people are going to advise them to demand a colonoscopy. Maybe even a colonoscopy and an EGD..”Better rule out everything first before giving the pepto a chance to work.” Its crazy and out of hand!
drcushing
This is a problem that begins with the Web. People think that reading some un-vetted posting or Web page gives them the same knowledge as four years of medical school, three to eight years of residency and many years of practice experience. The concept of patient-directed health care has been bandied about as a solution to our health care expense problem. If this is an example, we are in trouble.
Anonymous
OTOH, most cases of ovarian cancer are initally misdiagnosed – including mine, at age 40.
Anonymous
CA -125 is a test for peritoneal irritation, NOT Ovarian cancer. That is what I tell the patient. I almost never use it in premenopausal women as the false positive rate is almost 35%. I agree it has little use as an asymptomatic screening tool unlike the pap test or mamogram. Screening tests need to have very low false positive rate to be clinically usefull when the incedence of the diseases you are looking for are so low. The patient can sue! I would tell her why it makes no sense , educate her and then send her on her way out of the office and the practice! I don’t practice medicine on people who threaten me( unless I am forced to by ER call)
Anonymous
A year ago I would have agreed with all of you; I come from a family of physicians and personally hold four advanced degrees. (No, I am not a lawyer.) I have patients of my own and am forever wary of some kind of litigation. Doctors are honest, hardworking, honorable, and skilled, right? Hah! I recently read my own records after complications from a two-year-old missed fracture. My “medical history” had been recorded so inaccurately it is little wonder my injury was dismissed as trivial (and I was chalked off as a “whiner”). I have since sought medical care — not recourse — elsewhere, but no doctor will treat me. I have good insurance, and I’d be willing to pay cash if it would save my leg. I’ll never trust another doctor. Never.
Anonymous
I was about to give you my phoe number, until I read the last sentence. Good luck!

Screen me or I’ll sue

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