I see that lot of patients and relatives complain about doctor’s tendency to do lot of unnecessary investigations.
Obviously, most people also feel that we tend to do same, just for financial gains.
The subsequent points explain how it’s most times in best interest of both doctors and patients. I also thought it will be cool and time saving to refer to a blog post, rather than argue with some layman/patient over it (which I am doing a lot these days :).
How do we define ‘excessive’ or ‘ over’ cautiousness / investigative nature ? What is really excessive?
The patient might say that anything that is not required is excessive. However, the answer is, it differs fora particular investigation etc. and the list can go on.from every situation. It will depend on too many factors, which doesn’t include all but, patient’s current symptoms, findings on clinical examination, response to previous treatment, patient’s financial condition, the answer we require
For example
If I am worried about cancer or life threatening situation, no investigation might seem excessive from doctor or patient’s perspective. But at the same time, I might not do a Vitamin D test in a patient with poor affordability and minor aches and pains.
2. The following is the argument which forms a basis for lot of criticism of some doctors: ‘When I went for a second opinion to another doctor, he said that I don’t require the test and I was fine with some medicines he gave. Why did the first doctor ask for it ?’. I can explain why this is a wrong way to interpret our decisions.
Firstly, all doctors have different level of competencies and comfort level.
For example
If a patient goes to a local family doctor for severe abdominal pain, he might think about appendicitis and ask for urgent abdominal sonography. However, if you go to a general surgeon who sees a lot many, he might be able to tell you that it is not appendicitis just by clinical examination alone.appendicitis
Secondly, the scenario totally changes when you are taking a ‘second opinion’. The doctor who is giving you a second opinion always has a distinct advantage over doctor who gave the first opinion.
Example
Suppose in the above example, patient of abdominal pain, the pain already might have been waning off, if wasn’t appendicitis. Thus, the second doctor is more confidently able to say it’s not appendicitis without a sonography.start got a few investigations before sonography and reached the 2nd doctor after some hours of
Most of times doctor was valid only for his competency, your condition at that time and his/her reasoning.first visit and things might have changed completely till then. The advice of first the second opinion visit is days after
Similarly, a patient might already tried doctor, but since you have failed that they have an advantage in knowing the same.first therapy. He/she might have given you the same drug/opinion as step / alternative he can move on to next obviously have had some treatment and failed it or not tolerated it. The second doctor has an advantage in knowing that and
3. ‘The unpredictability of medical science, fear of missing out something sinister and the fear of litigation’
Consider this real life scenario
A headache specialist who sees a lot of patients with headaches,, even if he feels 100 % that it is going to be normal.headache days later patient has a seizure (fit) and he is detected to have a brain tumour. The family sues the doctor. The doctor now does at least one CT scan and/or MRI in any patient with Few headache the patient thoroughly, he finds no need to do an MRI in him, feels its migraine and sends him home on some medications. sees and he long standing clinical examination. One day he gets a patient with good avoids unnecessary CT scan and MRI in most patients with
Now as heading suggests, there are many things which makes this doctor over cautious subsequently;
Despite his experience, the unpredictability of medical science unfortunately brought him a patient with no findings on examination and still having a brain tumour.
This instills MRI in each patient even his examination is normal.advice a fear in him/her of damaging the patient, his reputation and also possibly facing litigation, so he gets MRI in every headache patient because he doesn’t want to go through whole trauma gain. He/she will
The more experienced or more reputed the doctor, the more likely that he will investigate in detail so as to not miss out anything. This can get costly for patient unreasonable to criticise the doctor for keeping himself safe first.its, but
Sometimes a doctor has to investigate in detail as the clinical examination is not exactly forthcoming.
Most times both the doctor and patient feel relieved if relevant investigations are normal. Peace of mind for the patient requires him/her to bear the cost of investigations.
4. How does a patient/individual then consider his interest in such a scenario ?
Always get a good medical insurance, always have contingency plan for medical costs. If you want best and safest medical care, it is going to be costly for most of the above reasons.
The patients scan always discuss need the doctor for ordering the test.criticise choice with all pros and cons about doing or not doing the test. If the patient doesn’t decide to do the test, it’s his/her wish and if they get better without the test – it’s your luck, don a informed of a test with his/her doctor and can make
The high patient load and poor comprehensibility of Indian patients at times is if you feel you have asked a reasonable question and you haven’t got a satisfactory answer you can always change your doctor.However too unsuited for making reasonable medical decisions, hence doctor might order a test in you without giving much explanation.
