1) A reader writes: “I’m curious to get your take on what three (or more) things patients (especially those with complicated histories or who need a lot of care) can do to make it easier for you to do your job.”
Ok, here goes:
i) Bring an accurate, updated medication list to every office visit.
ii) Understand that only up to 3 issues can be adequately discussed during a 15-minute office visit. Prioritize which issues are most important to you and address them first. Schedule another appointment if there are more than 3 issues.
iii) Ensure that consultants send a copy of their note, tests, and lab reports to your primary care physician in a timely fashion.
2) A reader writes: “Almost all doctors say that people should ask questions about all tests, procedures and drugs so they can make informed choices when advised about medical care.
However when in their own office, many doctors do not give their patients a choice but instead give ‘orders’. How are we going to rein in costs and reform the medical care system if people are not encouraged to ask questions and explore their choices?”
Good question. Patients are being encouraged to take more responsibility for their health care. It is a good idea to question the necessity and risks of the test, as well as the repercussions of not undergoing the test.
Various studies have shown that more tests do not equate to better medicine. If a physician does not, or is unwilling to, discuss testing to your satisfaction, it is time to find another opinion.
Related posts:
- Tips for convincing your doctor to order more tests for you
- Selling genetic tests directly to the consumer
- Do patient demands drive up health care costs?
- Ordering tests for other doctors
- Can patient empowerment be taken too far?
- Why doctors order so many tests
- Poll: Is easy patient access to the medical record a good idea?
{ 6 comments }
I’d like to second what the reader said about tests.
If one comes for a checkup, for example, it is often the nurse who does the EKG before I even get to see the doctor. Regardless of whether it is needed or not in my specific case – I am slim and healthy, but there is some family history, although all of it at much older age – the point is there is no opportunity at all to discuss whether this is needed or not beforehand. The nurse comes in and says – “I am going to do an EKG”. How are you supposede to reply without appearing “difficult”? Sure I can tell the nurse that I want to discuss it with the doctor first, but not without a significant loss of time.
With blood tests it is even worse. The doctor just marks a bunch of fields on the form and gives it to you at the end of the visit. He doesn’t tell what he tests for and whether some of the tests are needed. Worse, this happens at the end of the visit, when there is no longer any time left. He also gives a slip for the urine test. Now I know it isn’t recommended, so next time I question it. But most people don’t know.
Additionally, even knowing it, I’d imagine most people, myself included, would be afraid to appear “difficult” because of questioning something this trivial.
I also switched my ObGyn because the previous one wanted to do ultrasounds every year for no reason at all. I have POF, so she’d say “we don’t know why your ovaries failed”, but there is not a single cancer of these organs (I dare anybody to find any information otherwise) for which POF is a risk factor, if anything it is the opposite. There is no mention anywhere in any article or study on POF of any need for the ultrasounds.
Yet when a doctor gives such a bogus reason “we don’t know why your ovaries failed”, most people will find it difficult to come up with an answer. Not without extensive research that most people have no time for.
Then there is a whole issue of trust. If we question the doctor does it mean we don’t trust him/her?
Re physicians being willing to discuss the necessity of tests:
When is there time for this? I’m quite sure my doctor would be willing to discuss it if I asked, but on my last visit he was half an hour behind schedule and I was in his office for less than 10 minutes.
Who wants to embark on a debate on “are these tests necessary” with a physician who’s frazzled and clearly trying to keep up with his schedule? (no criticism intended, because he still managed to be careful and thorough.)
I know it’s my responsibility to ask, but I have to balance this with respect for the physician’s time and the other patients out in the waiting room whose problems may be a lot more serious than mine.
So how do we make the environment more conducive to allowing patients to bring up the question of necessary testing and giving the physician time to answer?
Oh yeah, and for the record, I declined a diagnostic CT scan that was presented as one of my “options.” It didn’t strike me as necessary, at least not yet… but this was a decision I reached on my own, without any input from the doctor.
I think a lot of us are looking for guidance… some kind of team approach for what’s best to do in our individual situation vs. simply being handed off to radiology or the lab or wherever. The frustration is that we’re constantly being undermined by the system we’re in.
P.S. I’ll save y’all the trouble of trumpeting the benefits of concierge care. I live in a rural area with a shortage of health care professionals – no concierge care for at least a 100-mile radius, nor ever likely to be. Although I’m sure it’s a great solution for some folks, the reality is that the concierge care model simply isn’t feasible in many areas.
As a family practitioner, I recently had a consultant tell me I am not doing enough ekgs, ua’s and labs, as these pad the bill and help us make more money. There are conflicting agendas at work and until there is an incentive to NOT DO something, things will still get done.
By the way, it is fairly common for patients to request (and sometimes demand) unecessary tests. Common examples are MRI’s for back pain and lyme disease testing. Just this morning, I had a patient insisting on a chest xray for bronchitis.
As a family practitioner, I recently had a consultant tell me I am not doing enough ekgs, ua’s and labs, as these pad the bill and help us make more money.
How is this morally different from stealing? If tests aren’t necessary or aren’t recommended at least have the decency of give us an option to refuse. In some cases we may be paying for it from our deductibe co-insurance; in other cases – it is insurance fraud. I can (kind-of) understand defensive testing, but doing it for financial reason is no better than theft.
I am not even talking about real potential harm from these tests like false positives…
Really, it is easier to refuse recommended tests nowadays than non-recommended tests. With most recommended tests there is at least some discussion. With non-recommended tests, the doctor just goes ahead and does it.
I don’t care about those who demand tests. If they want to be irradiated for no reason – it is their choice. If it is something expensive – let them pay for it. But those of us who don’t want it need some way to 1) know when a test isn’t necessary 2) have an option to refuse.
How is it that you think a patient can ensure that our specialists send copies of all tests, procedures, etc. to our PCPs? We can request it gets done, but really don’t you think they already know they should be doing that? A better way is for patients to just request copies of all tests or procedures themselves and bring them to all doctor appointments. That way if you don’t have it then they do. But, you cannot put the responsibility on a patient to make sure someone else does their job.
“As a family practitioner, I recently had a consultant tell me I am not doing enough ekgs, ua’s and labs, as these pad the bill and help us make more money.”
And they wonder why there is an increasing lack of respect toward the medical profession. You guys are making your own beds.
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