"My PCP keeps sending me for useless tests and referrals"

A reader on an “ask a doctor”-type forum wonders why doctors order so many tests and referrals. The response:

You are not alone in wondering what is going on in our health-care system. Doctors and hospitals are more concerned with liability prevention than providing consumer-friendly health care.
But don’t despair and don’t give up. There are good doctors out there who still care and they need to be encouraged.
You need to take responsibility for creating a positive outcome and thus make sure every visit to the doctor ends well for you.

Not sure what to make of that last sentence. How do patients “create a positive outcome”?

Comments

Anonymous
The answer to this person’s query makes the assumption that those who are forced to practice defensive medicine (which is almost all of us I’d think) can’t be good doctors. I’m also not sure how the person who answers this question thinks that the patient can find somebody who doesn’t practice defensively.
It would’ve been a lot more useful for the person to be told that defensive medicine is an understandable but unpleasant byproduct of our litigation system, and that if they want to be helpful they’ll encourage their Senators to stop filibustering medical malpractice reform every time a bill goes to the Senate. And, encourage their state representives to pass malpractice reform as well. Otherwise, good luck. Get used to unneeded tests and consults because they’re going to be a way of life.
Kungfukitten
I think “creating a positive outcome” would being compliant with what your doctor recommends. I can’t tell you how many times I’ve had an EKG because I get chest pain when I’m anxious and I go all tachycardic and hyptertensive when I set foot in a doctors office. However, it’s better than the off chance that I am having an unlikely heart attack.
Anonymous
anon 12:26, why do some of you insist on putting your problems onto your patients? 1st. of all, as patients, we are not trained to know what is a useless test nor to recognize when you are just being defensive with your medical expertise… You want us to trust you and then you tell us we shouldn’t. In fact we should distrust you so much that we need to write letters and approach our law makers to get things in your profession changed.
Why not get them changed yourselves? Why not ban together and do what needs to be done. Is it because you are too good to fight even when it is for a cause you believe in? Or, is it because you only want to fight the fights that you know you can win? Granted, this would take alot of fighting, but, once you start you would pick up support from many other places, including from your patients. It is not our place to start your fight. Fighting isn’t just about winning, it is more about need. Noone is in better position to change some of these laws than the physicians themselves. You are just sitting back and waiting for someone else to pick up the pitchforks.
Anonymous
Doctors are fighting to change things. It would be nice if some of the complaining patients like yourself would help them out by joining the fight to end lawsuit abuse instead of supplying the lawyers with an endless gravy train of sue-happy customers.
diora
What kungfukitten doesn’t understand is that all these extra tests can have risks – so “being compliant” is not always in our best interest.
What if instead of an EKG they’ll send you for some invasive procedure that has inherent risks of permanent harm? You may suffer your whole life from this procedure done for something you had 1 in 10000000 chance of having. You may even die from an invasive test. What is good odds for a doctor in terms of malpractice risk is not necessary good odds for you. 1 in a million chance of having your life saved is great if the risk is 0, but what if this risk is 1 in 1000? These are just random numbers, btw, I am not thinking of any specific test.
Similarly, a 2 year old sent for repeated X-rays or cat scans he/she doesn’t need can have cancer 10 years down the line. For a doctor trying to avoid malpractice the choice is clear. For a parent, maybe the probability of each outcome is more important.
The question I have is about talking to a doctor. How can we as patients convey to the doctor our refusal to have a specific test/screening without offending the doctor, without demonstrating our lack of trust while simultaneously showing that we truly made an informed decision and not one based on irrational fears or misinformation. This is something I constantly struggle with if I found some information. Shall I bring it up? How shall I word it? I don’t want to offend the doctor, I don’t want to waste his/her time, but I do know that I don’t want defensive tests and that I want to make my own decisions about screening. I think the main reason my blood pressure goes up before/during doctor’s visits just from thinking about these things.
Not sheepish
“we are not trained to know what is a useless test nor to recognize when you are just being defensive with your medical expertise”
Well, some of us are. I speak doctor like B. Billingsly speaks jive.
I don’t have a test unless I know what it is, why it’s being done, what the doctor is looking for. And even a total rube layman can look anything up these days.
Any doc of mine gets second-guessed every inch of the way, not that I won’t completely agree with him most of the time. I know just what to ask, and it ocassionally results in true happiness on the part of the doctor, but sometimes irritation or a look of fear, depending on the doc.
I’m not an evidence-based bot, though. I am not a cow in a herd, but an individual and expect my care to be very tailored, and with two pairs of pants. And since I can make it so, I do.
Anonymous
The ironic thing about defensive medicine is that no one even knows if it works! Why would you want a physician who is treating something with no idea if his proposed cure will do any good?
Anonymous
Diora,
In my experience doctors are not ordering ridiculous tests that have no benefit or that put a patient at risk for no potential benefit just to be defensive. I think doctors consider ruling out diagnoses that are a bit unlikely when without the malpractice enviornment we have now, those less likely diagnoses may not have been taken very seriously at all, and most likely with no detriment to the patient.
Pressure from health care providers will not encourage malpractice reform by itself. There has to be political pressure by the general public, but it won’t happen until people start to understand what a huge problem this is, and how it it contributes to the escalating cost of health care, the number of uninsured patients etc.
diora
Anon at 5:05 — I am not sure I understand which of my comments you are replying to or which question you are trying to answer.
Whatever the reason for testing, the fact is that tests are not risk-free. There is always a balance between the chance of individual benefit and chance of harm, even for tests that are shown to save lives.
Whether the reason is malpractice or a genuine belief in the test – the result for a patient is the same. In most cases – there is no effect except for cost. A few might even benefit. But a few more will be harmed (and in many cases the number of those harmed will be higher than the number of those who benefit). Even if a test is shown to save lives, the probability of an individual benefit is often extremely small and in some cases a balance of benefit/harm is subjective, so a reasonable person may decide to refuse a recommended test. If a test is not shown to save lives – like urinalysis, PSA or routine X-rays for smokers (not that I care much about smokers) the risks are at least as great than a chance of an individual benefit (if any). I don’t know if you are a doctor or a patient, but I think you are seriously underestimating the risks. If false positives and overdiagnosis is no big deal to you – great, but it doesn’t mean that it is the same for others.
Generic solutions are fine in the long-term – and I am all for them, but they don’t make a difference for an individual here and now.
Incidentally, the people will not change their opinions unless they stop believing that more testing=better care. And this information comes from everywhere -TV, newspapers,radio, internet. But journalists don’t just invent it. For the most part they get it from the doctors. So doctors are not entirely blameless here. Just pick a few non-recommended tests and google. You’ll find a zillion websites which recommend them, and many of those websites are written by a doctor or at least list a few names of doctors as reviewers.
Anonymous
Anon 5:05
How does defensive medicine contribute to the number of uninsured?
Is there a study which tells us how much less defensive medicine is done in states with “reform” and states without? Is health insurance cheaper in those states? Have health insurers promised to lower premiums if defensive medicine is reduced?
Considering defensive medicine, even at its highest guessed amount, is less than 10% of all medical expenditures, and presuming that we could lower it to $0, exactly how many people will be insured then?
Do tell.
Anonymous
Actually doctor’s themselves only account for 20% of all healthcare spending. You know anon 6:03 you are good at asking for studies when trying to make “your” point but I only get silence from you when I ask you to back up your statements.
PS: I am not anon 5:05.
Anonymous
What would you like me to back up? I’ll be glad to give you whatever you need, 6:03, or tell you if I cannot.
Not sure what point of the 20% stat is, though.
John J. Coupal
Not sheepish:
Surely, you can’t be serious !?!
Anonymous
Putting a % on how much money is spent on defensive medicine is about the biggest laugh I had all day.
Was there a survey where someone called Drs. or came around to them and wanted to know how many defensive tests they order in a day? Week? Month? And the Drs. answered that question honestly, right?
They don’t say, “yes, I ordered all these tests to protect myself but don’t tell the ins. companies.” Why do you think they all post anon here?

"My PCP keeps sending me for useless tests and referrals"

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