There’s a question that I’ve been hearing a lot of recently during appointments and it seems to be bothering me more than I had expected.
Recently, I had completed a lengthy appointment for a patient with an unclear medical diagnosis. The case was complicated.
I outlined a fairly extensive list of studies that would be necessary in order to diagnose and hopefully treat the problem. The patient stopped me.
“Are these tests really necessary?” she said.
“It depends on what you want to know and how badly you want to stop these symptoms but, there are no guarantees,” I said.
“Humph. You guys are like auto mechanics — no guarantees and no choices,” the patient said.
“I’m sorry you feel that way,” I said. “Let me explain it to you.”
She left the office without ordering the tests.
This kind of interaction is happening about half the time these days, and I think I know why it bothers me — it seems to imply I’m racking up the bill.
But I, like many of my colleagues, are salaried employees with no incentive to increase costs. Recent changes in insurance with a higher deductible and even higher copays means we’re all paying for healthcare costs more directly than we use to so everyone’s asking questions.
There’s a campaign by the American Board of Internal Medicine to help patients ask these questions. It’s called “ Choosing Wisely,” and it aims to help doctors and patients begin a conversation on the most overused unnecessary tests and avoid unneeded costs in the healthcare system.
I really like this campaign because it helps to put me on the same side of the fight with my patients. When it comes to money, patients are entitled to know why they’re getting a test, what the results are, and how it’s going to impact their care.
I’m troubled that the excess of healthcare testing has placed me at odds with some of my patients. Sadly, I guess that the true cost of healthcare waste is the strain on the doctor-patient relationship.