All physicians know the scenario. You want to reassure the patient; the patient wants another (usually expensive) test.
In our new metric age, we may have a conflict between overuse and patient satisfaction. The article provides some hospitalist data: “Hospitalists know guidelines but overuse tests to reassure selves, patients.”
How do we balance making our best evidence-based decisions with patient demands? Some experts will tell us that we really have a communication problem. If we were just better at explaining the data, the patient would agree. Those experts do not take care of the same patients that I see.
Diagnostic test overuse is a huge problem. Unnecessary CT scans put patients at future risk of malignancy (admittedly a small risk for each one, but CT scans seem to add up quickly). Unnecessary tests explain a significant portion of the cost curve. Unnecessary tests find incidentalomas that lead to more testing and more expense.
We have a serious problem with the patient satisfaction metric. We have to disappoint patients sometimes. We should not order tests that we know are the wrong tests. We should not just agree to give patients opiates when we know that they are either being abused or sold on the street. We should not automatically get a subspecialty consult when we do not have a good reason to add another physician (and usually more testing).
This conundrum exists because someone sees us as providers and patients as customers. I am not a provider; I am a physician. And the patient is not a customer, he/she is a patient.
We should all try to deliver care that fits the patient. We want satisfied patients, but when we spend money to try to buy satisfaction then we become compromised, and patients may get harmed.
Robert Centor is an internal medicine physician who blogs at DB’s Medical Rants.