Should I avoid talking to my doctor and jump right to tests?

Should I avoid talking to my doctor and jump right to tests?
An excerpt from 
The Thrifty Patient – Vital Insider Tips for Saving Money and Staying Healthy.

Do I really need an MRI?  Do I really need blood work? This often? Should I avoid talking to my doctor and jump right to tests?

Americans love technology, whether it’s carrying the latest iPhone or buying the newest flat-screen TV with 3D technology. Naturally, our fascination with technology has spilled over into medical care, where everyone, including doctors in training, seems focused on what the x-ray, CT scan, MRI, or blood work showed.

Sadly, this trend is seriously misguided. More testing does not lead to better care. More testing does not lead to more accurate diagnoses. Research has shown that Americans receive too many tests and procedures compared to other countries. If anything, more testing seems to be associated with worsening health. The leading cause of radiation exposure is too many medical scans, such as CTs. The worst part? With all of the additional testing, as a country we spend more and are less healthy than other nations!

The truth is that a test, whether through blood work or imaging studies, is merely a tool and a clue. The test results are not the absolute truth. They do require some interpretation. People are far more complex than a simple blood count, an x-ray, or other lab test. In isolation without a patient story, these results are meaningless and not helpful. In the hands of a good doctor, these clues can be tremendously helpful. In the hands of a less-skilled doctor, they can result in unnecessary additional testing, worry, and misdiagnoses.

Where did this false faith in the power of testing come from? Perhaps it has been due to the popularity of medical dramas such as ER and House, where the public witnesses the dizzying array of tests being ordered. No one leaves the hospital without something being done. Perhaps we feel compelled to get testing done because co-workers, friends, or family members who talk about their health issues seem to get a lot of tests done. Are we doing something wrong if we don’t get tested? It’s extraordinarily hard to go against popular trends, even if they are wrong for both doctors and patients. Although some doctors argue that overtesting is to prevent malpractice suits, this is only part of the story.

Doctors are also prone to this misconception that tests reveal the absolute truth. In the book The Empowered Patient, CNN Senior Medical Correspondent Elizabeth Cohen highlights two misdiagnoses by doctors because they relied only on a test result, the biopsy report. They didn’t interpret the result in the context of the patient. The results didn’t make sense given the patient’s medical history. Thankfully, both patients avoided unnecessary and potentially dangerous therapies because the patients discovered their diagnosis didn’t fit the typical profile. As noted previously, a test result is simply a test result. It doesn’t give you or your doctor the truth. It is merely a piece in the puzzle. In the previous examples, the piece was for an entirely difference puzzle! Even doctors can rely on these tools too frequently and make serious errors.

Why is this important to you?

In the future, you will be more responsible for costs, including blood work and imaging studies. Your doctor probably won’t ask you if you can afford to do the test. If you don’t stop him, you might get tests you really don’t need. Help your doctor pick what tests are absolutely necessary by asking the following:

What is your diagnosis?

How will testing help with the diagnosis? Are there other alternative diagnoses or possibilities you are considering? What are the consequences of not testing? Do I need it now? Can I safely wait or postpone testing to see if the condition improves? Will the testing change the treatment plan? If so, how?

Davis Liu is a family physician who blogs at Saving Money and Surviving the Healthcare Crisis and is the author of The Thrifty Patient – Vital Insider Tips for Saving Money and Staying Healthy and Stay Healthy, Live Longer, Spend Wisely.

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  • rtpinfla

    I hope that someday this message takes hold in the US patient population.
    As an allergist, used to spend a lot of time trying to talk patients out of doing unnecessary testing for a variety of ailments (especially food testing), even though it was in my financial interest to proceed with the testing. I explained to them that their symptoms in no way resembled an allergy, that the allergy test to food will not reveal why they have chronic fatigue or headaches, etc. I tried in vain to explain that One too many patients “voted with their feet” and/or panned me online for being a terrible doctor.
    Nowadays I test almost all of these patients. I also tell them that the testing probably won’t help and they will continue to have their problems regardless of the result, but if they want the test I will do it and they can use the results however they would like.
    Now those patients love me, I don’t get an ulcer from having patients run me over the coals or accuse me of withholding care, and I make a lot more money. Sometimes they come back after the test and I try to steer them to the appropriate specialist.
    Moral of the story: the old adage, “Do what’s right for the patient” has morphed into “The customer is always right”. Maybe someday a physician opinion will matter again

    • drgz

      I think this fits perfectly in todays practice environment of procedures and tests.. Thinking and experience from the doctor or the art of medicine are not valued. Only evidence based medicine.
      On the other hand, as was pointed out in this thread, misdiagnosis even when pts have serious problems can get missed and be very damaging to pts.

    • http://www.davisliumd.blogspot.com Davis Liu, MD

      Agree that depending on where you work, based on salary or based on productivity / number of visits, the financial incentive can be aligned so doctors and patients get more unnecessary testing. This of course produces two issues – increases in health care spending and also an “expectation” that the right thing to do is more tests rather than talking and listening.
      Talking, listening, and building relationships seems to be something that is increasingly missing in today’s society and not just in health care. That trend may also play a role in why patients expect more, which in many cases are not needed.

  • http://www.thehappymd.com/ Dike Drummond MD

    Great post Dr. Liu – and let’s answer the question posed in your title.

    If you want the doctor to TREAT YOUR TEST RESULT … go straight to tests by all means.

    If you want them TO TREAT YOU … as the unique individual, with the unique personal and family context that is your life … then you might want to talk to and be examined by them first. Yes?

    IMHO Tech is NEVER a substitute for a human interaction. It is an adjunct to a fundamental human connection between the patient/client/customer and their family and caregivers. The human connection comes first … unless you are the kind of person that likes automated phone answering systems for your most important healthcare decisions. “The algorithm will categorize you now … beep”

    Some will say that there are some medical interactions that can be handled by tech – where you get a test and a program/cell phone gives you the results. However, you (the patient) will almost always have questions about the meaning of the result or the appropriate action or complications or cost … and you need a HUMAN to be there to answer them. Tech is an adjunct.

    Dike
    Dike Drummond MD
    117 Ways to Prevent Physician Burnout in the MATRIX Report
    http://www.tinyurl.com/bpmatrix

    • http://www.davisliumd.blogspot.com Davis Liu, MD

      Great points! Completely agree.

  • Suzi Q 38

    I understand what you are saying.

    In my case, the MRI’s that I wanted would have saved me from my permanent leg weakness and limb neuropathies. Ditto for my lower back pain. Instead, I went through almost two years of escalating pain and neuropathies urinary and bowel function problems, and leg weakness.
    this was after the lumbar MRI showed nothing. I asked for more MRI’s on other parts of my spine, but of course, my neurologist said that that would be unnecessary. It turned out that I have severe spinal stenosis in my c-spine. I had an episode where I could barely walk one day. So dramatic. That’s what it took to get the test I needed.

    The MRI on my knee would have saved me the year of misdiagnosis and pain. I also had undergone an ultrasound, Catscan, and Xray prior to the MRI. I asked for the mRI first, but the doctor declined, telling me my problem was nerve related, or a “thrown clot,” as the leg in question was so swollen that it was larger than the other leg.

    I was not so sure. I teased him ( I have had the same PCP for 12 years) and said that I thought it might be mechanical, due to an old soccer injury. I felt the bone hit bone every time I moved my knee.
    A year later, the MRI showed that I had no cushion left around my knee, and chips of bone were floating in excess fluid space. There were other mechanical problems, too. I guess no one has a “crystal ball”, LOL.

    Please understand that not all of us ask for unnecessary tests, especially if you look at our prior medical records. If all of a sudden things get more complicated, we are not making this stuff up, we need the tests.

    • http://www.davisliumd.blogspot.com Davis Liu, MD

      Agree. Listening to patients is very important to figuring out what the right test is. With a dizzying number of tests available, it is important to have a doctor who listens to you and partners with you so you get better.

  • elizabeth52

    It’s a huge problem, but it’s difficult for many American and Canadian women to avoid harmful excess if they want the Pill. I was horrified the first time I heard about the well-woman “requirements” and that women were actually denied the Pill if they declined these unnecessary exams, and cancer screening has nothing to do with the Pill. Screening is always elective and legally and ethically requires our informed consent.

    The American practice of denying the Pill to force excess/screening would amount to professional misconduct in many countries. (and quite rightly)
    I’ve even heard of doctors “requiring” mammograms or they refuse the Pill or even sack the patient.

    It makes you wonder what’s going on, that a doctor could feel it’s appropriate to treat women in this way. No wonder more women are taking a trip to Mexico or buying the Pill online. It shouldn’t be necessary…
    I’m very cautious and refuse anything that doesn’t pass my risk v benefit test. Sadly, we can’t trust the medical profession to act in our best interests. (or many of them anyway)
    The routine bimanual pelvic, rectal, recto-vaginal and breast exam are not recommended here (Australia), they’re not evidence based and carry risk to our symptom-free bodies. I’d never permit them.

    Routine visual inspections of the genitals (promoted by some US doctors), are not evidence based or recommended here either.

    Excess is unhelpful and usually just exposes us to even more risk. Screening needs to be approached cautiously…rejecting cervical screening was easy for me, low risk woman + rare cancer + high risk of false positives and potentially harmful over-treatment = no, thank you.
    (I now know I’d be HPV- and cannot benefit from pap testing)

    Breast screening – false positives + over-diagnosis + the risks with over-treatment (heart attacks, lung cancer etc.) and uncertainty of benefit = no, thank you.

    We CAN say no, over-screening, over-examining, non-evidence based screening/testing etc. is not in our interests and sometimes, no screening at all is even better. It’s our choice. I’d sack any doctor who attempted to coerce or pressure me into screening or excess.

    • Guest

      Because the “morning after” pill is now available over the counter to even teenagers, I can’t see why the regular birth control pills aren’t as well.

      Except that doctors wouldn’t like that, as they like to use their monopoly as the only place a woman can get birth control pills, to blackmail perfectly healthy women into getting all manner of invasive and demeaning exams done.

      If an American woman wants the pill, she has to pay for it by letting a stranger do sexually invasive and largely uneceessary “exams” and “tests”. Blackmail! It’s horrible! Why aren’t the Sandra Flukes of the world screaming about a #WarOnWomen here??!!

  • ninguem

    Well………you CAN run right to tests, right now.

    There are free-standing clinics in both radiology, and in laboratory testing, willing to run blood and urine tests, and at least some diagnostic imaging, on demand.

    Walk right in to those clinics and get all the testing you want.

    And pay for those tests out-of-pocket.

    Where you need the physician order is for INSURANCE PAYMENT. But if you’re willing to pay out-of-pocket, you can run right to tests, right now.