Diagnostic Overkill
My husband went to the doctor for a physical mostly because he was tired of dealing with symptoms of dyspepsia. He was young, physically active, had no other known health problems, no family history of heart disease and did not have any bad habits. He had an EKG which showed some minor abnormality. The doctor was unsure so he was set up for a stress test. It came out completely normal as expected. It should have been a relief to us but we thought the doctor went overboard, probably out of concerns about liability. When we later changed insurance, this issue came up and we had a little difficulty getting him insured.
OK, my husband is young and it should be worth it to undergo all the tests to make sure he is healthy and will enjoy a long life. But is it really necessary to undergo a test like an ECHO, which is expensive, just because the doctor is a little unsure? What happened to doctors being trained to recognize signs of heart disease? Are medical schools turning out diagnosticians or medical practitioners?
Now take the example of my 90-year-old demented great-aunt who is bedbound. Essentially, she has reached the end of her life. So why would the doctor want to check an ECHO to follow-up on her Congestive Heart Failure? What difference will it make now? So what if the test will be covered by Medicare? The cost will eventually come back to taxpayers, who are already complaining about Medicare cutting back on reimbursements.
Another aunt, in her 80s, has had several strokes attributed to carotid artery stenosis. She has had a couple surgeries for it and does not want any more. She knows that she is at high risk for another stroke and the last ultrasound shows the blockage is at 80%. Must she still have frequent ultrasounds? Granted it is noninvasive, but is it necessary when she will not have anything done for it?
Is the concern about malpractice leading doctors to order more diagnostic tests than necessary? If your physical exams suggest a diagnosis for which the patient does not want treatment, must you order tests to confirm your diagnosis? Are you hoping to scare them into undergoing a treatment they do not want?
Filed under: Medical Dilemmas