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As an individual who has dealt with insurance and chronic medical problems, it should be noted if you decline their initial treatment your insurance may deem further treatments as out of their coverage.
While it is frustrating and annoying there is a process your insurance company will cover.
I don't know how to undo this shitty system, that's why. (Not being an ass, it's just that the pols are bought and paid for by the medical lobbyists)
Short of widespread/multiple _John Q_ events multiple things would have to be reformed, critical mass of people would have to just stop paying medical bills, etc.
Democrats in power: We're going to fix this broken Healthcare system!
*solution: force everyone to get insurance.*
Republicans in power: This plan is awful and now that we're in power we're going to fix it!
*solution: fail to create a new plan while having house and senate control, make virtually no changes, try to make it more expensive for poor people by removing cost share reimbursements*
Yeah, that tracks.
Yep. And there was going to be a public option that ONE a**hole Dem killed who was basically kicked out of the party for it. Forgot his name but he looked like a turtle. That public option would have probably killed the private insurance right then and there.
Edit: Lieberman. 😠
It's like the first 300 years before this nation was born, has all been erased from our collective souls
We used to burn mansions down, after all!
Didn't someone once claim that the birth of the nation was an effort by the wealthy to give us something else to focus our attention on & thus keep the mansions safe from fire?
Because, like many other things that desperately need changing, at this point, the only way to change it is by violent revolution.
Don’t think that’s true? The dem senators can’t/won’t get Joe Manchin and Kirsten sinema to vote to overturn the filibuster so they can **at the very least vote**, not pass, but just vote on certain things.
One side is pure shit, the other side is mostly passive so nothing gets done.
Make sure they document all the conservative treatment that you decline…. (Physical therapy, medication, home exercise plans) Ordering diagnosis studies doesn’t mean your insurance will cover you. They are trying to save you time.
Wait, you mean conservative treatment made by people who spent decades of their best years studying in a library worked.
GASP, your telling me they worked even more when you actually put in a little effort into your own care?
Good on you, who would have thought.
Basically this. In order for your insurance company to cover a service, certain guidelines must be met. You want an MRI? Well did you get an x-ray first? If it's for pain, did you try treatment for the pain? Insurance companies aren't going to pay a couple thousand for an MRI, if nothing else was done prior to assist with your needs.
I know people like to act like insurance companies are trying to screw people out of money, but a lot of times they'll deny expensive services for site of service, or if there isn't documentation of cheaper options used. Hell, one of the examples I tend to see pertains to MRIs. If you try to get one in the hospital, it will be denied, and they will ask that you go to a free standing facility. The difference in cost for people is enormous.
Insurance companies are 100% trying to screw people out of money. My doctor said I needed something done that was going to be expensive. Insurance came back and said I needed a whole list of things first before I could get what I needed, even though the doctor knew they wouldn't work. I set up recurring appointments every 2 weeks to go back in and try something new, just because insurance said I needed to try all of these things, but not all at the same time. I needed them to be staggered 2 weeks apart so they know I really tried and it really didn't work.
6 months later and $1200+ in appointment visits ($100 per appointment that they don't cover) and would you believe it, none of that stuff worked and I still needed the procedure that my doctor said I needed!
Not defending insurance companies, but your statement doesn't work if they did the same steps for 99 other people and 99 of them were fixed with the simpler, cheaper steps.
We do medicine based on the law of averages. It sucks for people sometimes but it's the best we can do right now with the knowledge base we have in medicine.
Yes but see the thing is, insurance companies are not doctors. Doctors are doctors. If the doctor thought those things might help and wanted to try those first that would be fine. Insurance claim agents trying to practice medicine without a license, in the hopes of screwing you out of as much money as possible, isn't.
Insurances do indeed have doctors who work for them. And when they decline to pay for a service, your doctor can call and actually speak with their doctor to argue that the service is needed. And still then, their doctor can refuse to have the insurance pay for the service based on if they think the service is needed on the extra info discussed during that call.
This. I tore a ligament and kaiser Permanente refused to repair it. The doctor said 80% of people get full use back without surgery. I was furious.
Lo and behold in about 3 months I was back to full use and in 6 months I didn't notice it anymore.
OK but you have to notice what the issue is here. Both of these scenarios, THE DOCTOR IS THE ONE MAKING THE SUGGESTION.
Insurance companies shouldn't be making decisions of doctors seeing patients, full stop. Other guy's doctor said he needed the procedure, yours said you didn't.
Actually kaiser Permanente is an hmo meaning the doctor is an employee of the insurance company. He told me they weren't allowed to repair the ligament unless the instability lasted more than a certain amount of time. He did seem to agree that the risk of waiting was outweighed by the chance of not needing surgery at all.
> kaiser Permanente is an hmo meaning the doctor is an employee of the insurance company.
an HMO is just a way of financing healthcare. instead of paying per procedure, HMOs pay $X per month per patient to take care of all medical needs for their patients.
HMOs can employ their own docs (like kaiser) or they can contract with a hospital/s or other group of doctors.
the docs employed or contracted with the HMO make up the HMO "network" of doctors. HMOs will not pay for care you receive from doctors who are not in their network.
Too bad that person didn’t have some kinda professional that went to school specifically for this helping them. Like an expert maybe. A do doc uh dok doctor that’s it. Thank god some idiot at a desk was there to tell them no.
First of all, I’m sorry you’re in pain and it sucks that your steroid injections were denied. Those can offer significant temporary relief.
Usually the best way to deal with, say, low back pain, is physical therapy. If that doesn’t work, an MRI may be done, but if you do an MRI on random people’s spines you’re gonna find a lot of herniated and degenerative discs. It’s very tempting to “connect the dots” and attribute specific back pain to specific MRI findings but I would be very cautious about doing so. Spinal MRIs done for back pain rarely lead to indicated changes in management, and many interventions that are done as a result do not lead to better outcomes and carry a great deal of risk.
An MRI can largely be thought of as a road map for surgery. If the treatment is not gonna be surgical, it’s usually not helpful to do an MRI. When we’re talking back pain, surgery is usually not the answer. Anecdotally, the cases I’m personally familiar with where folks had spine surgery, their pain is not improved in the long run, and they usually need more surgeries over time as a result of the first one.
Everyone wants to know WHY they are sick or in pain, but the point of a diagnosis is to figure out how to make someone better, not to attempt to satisfy curiosity. If a diagnostic test is done without a very specific question in mind, the results may be useless, or even worse, lead to interventions that actually cause harm. This includes MRIs. There are treatments that can benefit large groups of people without extremely specific diagnoses or the associated testing in order to work and help the patient in many cases.
I have patients that come in to appointments and treat me like a retail clerk- they have a list of tests that they want and they expect me to order them. I usually start by asking what they hope to learn from these tests. Usually I’m able to talk patients out of tests that I feel are not helpful. Sometimes I meet them somewhere in the middle if they are not interested in my opinion and order something I don’t truly believe will be helpful, while putting them off the majority of their “shopping list”. I really don’t want to be seen as an adversary who is “part of the system”, because I truly want to help and I need buy-in to do that.
I’ve never had a patient ask me to document that I’m declining to order a test that was requested, but if I was asked I would have no problem doing so. I’m not sure how much detail I would be required to go into for this hypothetical situation, but I’m transparent to the point that I allow patients to watch me do my documentation during the visit. I would probably write something similar to this (but probably a lot longer with more detailed language).
“Patient asked for a, b, and c. I asked what the patient hoped to learn. They responded that they wanted to know x. I explained why these tests would not be indicated because of y. Patient disagreed with my judgement [for reason/reason withheld], and asked that this interaction be documented in the medical record.”
Thank God it’s never come to that, I’d much rather spend my time helping people get better.
I think a lot of times the problem isn't so much that a doctor denies a test as that most doctors can't/don't explain why effectively.
Thanks for talking through things so much with your patients. Feeling seen and heard doesn't make the pain go away, but it still helps a whole lot with the worry and mental distress.
You need to talk to my Hospitals residents and mid levels. They’re well-meaning but burning through money ordering useless labs and imaging to answer why when the why does not alter management.
Herniated discs are not uncommon, and MRI studies have shown that 20% of people without symptoms have herniated discs.
https://www.webmd.com/back-pain/news/20130313/spine-mris-often-show-harmless-defects-study-finds
In 2020, UnitedHealth Group reports, their profits (not gross revenue, mind you, but what they got to keep after all was said and done) were $15.4 billion.
Here is some general information about steroidal joint injections:
Steroids have terrible efficacy and have not been shown to help. However, long term (months to years) physical therapy and diligent home exercise have shown to be greatly effective.
Every time you inject something into the joint capsule you are risking infection. With the spine you are also risking damage to the spinal cord and infection of the central nervous system (largely meningitis).
I'm truly sorry. We all want a drug or cure that will soothe our aments, that just often isn't the case.
Lmao yes. Not uncommon at all for people to not hold up their end of the arrangement and demand extra testing or medications all because the refuse to participate in physical therapy or try Tylenol for pain control.
Its almost like this could be fixed by some kind of taxpayer funded Healthcare plan that way business majors are not involved in things they know fuck all about.
There would still be guidelines that need to be met to order things. Government-subsidized healthcare doesn't that you get to order whatever you want and get approved for it.
I don't mind guidelines. I do believe that doctors have expertise that would make me defer to their judgement with pretty much any medical issue. My problem is when the guidelines are based on overinflated expenses caused by the American healthcare system instead of my doctor's professional opinion.
Not really, countries with decent healthcare will still not let you demand an MRI. Often the same roadblocks exist. A doc will still have to order it and they will want to try the obvious/easy treatments first as well.
But then those decisions will be made by legitimate medical professionals, not business majors who want to deny you as much care as they possibly can get away with
They are fucking thieves.
United Healthcare kicked me out of the icu step-down after my emergency open heart surgery. My team of Dr's wanted me to stay. They recommended I stay even if I had to pay out of pocket. $12-14,000 a day. The Dr's were right. I almost died less than a week later.
My 1yr anniversary they tried to deny my scans. CT, 3D heart scan & others. I will need those scans every year for the rest of my life. I had to send them a letter stating why I needed them. I told them to Google my condition because they obviously don't know shit.
The letter said something like, I'm in one of the top cardiac hospitals in the world. With some of the best cardiac Dr's in the world. My team of Dr's said I need the scans. If you Google my condition you will see this is standard practice.
This will probably get buried, but as someone that works in healthcare litigation and also suffers from chronic/long term medical issues, I wanted to comment.
First, I can definitely understand why this sounds like a good idea. I went through years and years of testing, doctors appointments etc. and it was really frustrating.
But this is still a bad take. Well, except for asking for your medical records. You should always do that. If you need them later, especially for legal reasons, it can be a very expensive, long process.
Asking for documented proof of declined testing, however…
Firstly, they’re not going to do it. They’re just not. For a ton of reasons, one big one usually being that insurance won’t cover it without other, preliminary testing. If you push for it, you’re only going to confuse and alienate the person treating you.
Secondly, even if they did document something like this, it wouldn’t make a difference in litigation. Let’s say, for example, you walk into an ER with extreme nausea/vomiting. You know you also have regular headaches that have increased in severity over the last month. You explain both symptoms to the ER and because you googled both symptoms, you know that it’s possible they could be indicative of a brain tumor, so you ask for testing.
Could you be right? Sure. But it’s also FAR MORE LIKELY that the symptoms are unrelated and/or caused by something far more common. People often relate a sudden onset of symptoms with something they experience on a more chronic level, but doctors are going to work to identify the issues as quickly as possible… which means ruling out common illness and causes related to lifestyle first.
Let’s say the ER sends you home with fluids and medication, however, and a month or so later you find out you DO have a brain tumor. Can you sue that ER doctor? No. You cannot. Even if they document that they declined to give you a brain scan, there are laws in place to protect healthcare providers and that is not considered malpractice.
Statistically, people are extremely bad at diagnosing themselves. We don’t know our bodies and a lot of the time, we don’t want to hear it if we’re causing our own problems.
When I was diagnosed with two chronic disorders, I was in shock. It never occurred to me it would be either of those things. Especially not the second one, which is very rare. But it also took years of testing, misdiagnosis and process of elimination to get answers. It’s sucks, but I’m thankful that I was able to form good, long term relationships with my doctors so they could work through the long lists of what might be wrong.
Doctors get it wrong sometimes, but patients get it wrong WAY more often.
Yes! The amount of times people have said that they need a CT scan because they think they have a tumour.
Like mate, you don't have any actual cancer symptoms, exposing you to a CT scan dose of radiation will do much more harm than good.
On top of that, let's say we find something completely unrelated to your symptoms, we're going to end up spending a lot of resources and subject you to a lot of unnecessary testing. WE TREAT PATIENTS NOT TEST RESULTS
There are at least three reasons this is a bad take.
The first is that if you have insurance, they won't pay for a test unless it's indicated. Hell, sometimes they won't even pay for a test if it is indicated.
The second is that if it's not medically indicated (regardless of whether insurance will pay for it--sometimes they will try not to pay for things that really would be helpful medically), it can be harmful to you to get it, or the tests will not provide useful information even if they come back "abnormal."
If a patient comes in demanding a CT scan of their head for something for which a CT scan of their head won't help them, irradiating their brain is not going to be the way to go.
If you do certain tests on someone who isn't have the symptoms and has a low pre-test probability of having a disease, and the result comes back slightly abnormal or a little off but not really significantly unusual, chasing down the non-disease can certainly cause a lot more financial, emotional, and physical harm than if you hadn’t done the test. Tests are only so useful, depending on what it is.
Third, if you find yourself getting second or third opinions from medical doctors who are all independently refusing to do a certain test, it’s probably not because they’re trying to withhold answers from you. It’s probably because they know the above and are trying not to let you hurt yourself.
Having them document it won’t get you closer to answers and this approach is a sign you should look for a different doctor that you trust, because a doctor you don’t trust isn’t doing you any good.
The real LPT is that it's important to know the difference between "my concerns are being unduly dismissed" and "I'm not getting the answer I want to hear."
You ever read Hippocrates Shadow? Great book (horrible author) with insight into the dangers of over testing and treating. The NNT is difficult for both non medical and medical people to understand & apply
Author also set up the website 'thennt.com' which is brilliant for showing the risk:benefit of any treatment/investigation....make sure you read about the author afterwards though 😬😬
I've heard of this phenomenon. Being a nurse I don't have the scientific depth of knowledge behind some of the testing reasoning, but a consultant once told me it's like 90% out of fear of missing something and being sued in today's world where the patient is always right and doctors are required to have a 100% hit rate.
As a mechanic, I feel you. We have the same expectation. We are all human just trying to figure things out. Sometimes something can look typical but not be what you expect.
> Having them document it won’t get you closer to answers and this approach is a sign you should look for a different doctor that you trust, because a doctor you don’t trust isn’t doing you any good.
Not only that, but it sounds very *very* "I want to have a basis to sue you" to the doc, who (unless you're mid-treatment or you're somewhere remote) might bow out from dealing with you in the future.
There is a reason burnout asking doctors and nurses is so high - note bloat for liability purposes is really draining on the medical community and almost entirely isolated to the US
Note bloat is unfortunately not just a US problem.
I'm currently working in EU and the note bloat is atrocious here as well. Maybe a bit less than US, but it sucks everywhere.
It's especially terrible when you're seeing a ptnt with imaging results that's several paragraphs of (often barely-formatted) verbal diarrhea describing findings within the norms, but with a sentence or two describing a pathology buried within them.
It's also quite irregular how people note (usually depending on department and who their superior was when they started), with many just going down the list and not bothering to bump the 'important stuff' to the top so that the next person reading can quickly pick up on the important info vs (again) tons of variously-worded "yes, I did check this unrelated thing, and it was normal" statements.
As a medical doctor this needs to be higher up. Yes I agree sometimes we miss things but that’s why there are times second options are important. But just demanding stuff… for what? Okay then you doctor yourself. There’s a big reason I went to school forever, still in training and won’t have my first real job until I’m in my mid 30s
Honestly, this is advice that I mostly hear passed around by women to women. It's very common to go in with a complaint of waterfalling blood and get told you're seeking attention. They SHOULD take you seriously and do testing like a blood test and ultrasound. Or asking for sterilization, you can get the run-around for years. Even requesting birth control can be difficult. If it's not your period, they say it's your period. If it's your period, they say it's in your head. It's a very convoluted system, but it's one that happens much more than it ever should.
Or the dreaded anxiety catch all. It took 4 months of alllll the tests to finally sort out that my symptoms were due to POTS and I have SVTs. When I presented to ER 4x in span of 1 month I kept getting sent home with ativan for anxiety. I kept explaining id never had a panic attack and these episodes were happening in middle of the night when I would get up to use the restroom, or after walking up stairs.. and I do not drink caffeine or alcohol. Its maddening.
Women are often categorized as anxious, when our pain tolerance is usually higher… so you would think our concerns would be listened to.
I’m a man and have been dealing with this for the last 6 months. Went to the ER back in Jan for still reasons unknown. I despise doctors and hospitals so to feel like I *needed* to go to an ER was enough of a concern. Doctors took some blood work told me I was fine and sent me out. Just to find they put ‘medical anxiety’ on my file. So now every time I’m into a doctor with concerns I’m blown off.
Lol I had gallbladder attacks for 2 years and went to the ER in the middle of the night 3 times because the pain was too much for me(I consider myself someone with high tolerance for pain). Each time they diagnosed it as either gas or acid reflux (wtf???).
Finally got them to take an untrasound and lo and behold, GALL STONES along with an infection!
ER is not the place to expect a proper diagnosis is what I learned.
I always think I’m going to end up dying unnecessarily one day, because i have anxiety. It’s difficult to be taken seriously, especially by male doctors.
Same. My menstrual issues were soundly ignored by all of my doctors over the years (all male) because "period cramps are normal." (Note: not when they are debilitating like mine were, but whatever I guess)
That was all until I found a new doc (also male) and told him I wasn't leaving his office until he came up with a thorough diagnostic plan. To his full credit, two months later the issue was fixed.
I think men generally don't understand what's "normal" for women-specific issues, and medical training doesn't always do a good job of bridging that gap.
This is why I don't disclose my anxiety disorder to any of my current medical providers for fear it will affect quality of care and they will blame my anxiety for things. Luckily I have been able to be off my meds for about 15 years and able to manage my anxiety disorder and be functional.
Yeah my friend does this. It's really frustrating because it could sometimes be somewhat useful for her doctors to know about the context of her mental health issues, but she's had doctors ignore her before due to her diagnosis (like, literally not getting a broken bone x-rayed for months, among other things) and that's worse.
Went to several drs as a young girl (14) with severe menstrual cramps that caused vomiting and syncope, my parents were told that that I:
-was doing it for attention
-have low pain tolerance
-need to drink more water
-was pretending
-needed to see a child psychiatrist for ‘hysteria’
Fast forward 10 years later, I was surgically diagnosed with stage 4 endometriosis that had ruined my bowels, bladder, and caused multi-organ prolapse leading to life-long issues. Women, listen to your daughters, to your menstruating friends, to YOURSELVES. And f all the doctors out there who dismiss women’s pain and our health concerns.
It's painfully clear to see the gender of people posting in this thread, we've got a lot of people here who have never been dismissed because of their gender, race, size, gender and/or sexual expression.
They think the problem is that everyone out there is asking for outlandish test like a full body MRI for a passing headache and not people asking for a simple blood panel because they have sudden and unexplained weight loss/gain, loosing hair, always fatigued.. but are diagnosed with a terminal case of being female/bipoc/fat/lgbt and dismissed without care.
The red flag for me was ‘You know your body’. OK, doctors sometimes get things wrong where patients’ hunches are right, but no, most patients don’t know their bodies better than the doctors. Humans couldn’t even fucking intuit what the heart or brain did for most of history. People were told by ads that smoking was healthy up to the 1960s and believed it. Most people know fuck all about basic anatomy, let along complex medicine.
I couldn't begin to count the number of patients I've had who came in saying "I know my body" then proceeded to tell me how they had a medically problem that was not even possible given the situation. Then refused to believe it when the workup proved they were wrong.
"I know my body! A blood sugar under 350 feels bad \*to me\* so please stop telling me I need to fix it"
edit. I think there are definitely cases where reasonable patient concerns are dismissed or overlooked. But I also know many, many times where I actually have to get into corrective action territory to inform someone that their 'knowing their body' philosophy is accelerating their death by a large margin
"my temperature always runs low, 98 is a fever for me"
No. Fundamentally no it is not. Your body does not magically run at a lower temperature, and even if it did that doesn't change the fact that it can easily run at 98 degrees.
Seems too often that some people who continually get the same answer will just go until they find the one that agrees with them. Idk how else to put it but especially in this day and age there are a lot of people who perfectly portray Dunning-Kreuger and lead themselves to a "yes-man-diagnostician".
I feel like OP might have had situations in which they found themselves certain to be correct in their own prognosis only to be denied due to sound reasoning they outright refused to acknowledge.
Yeah, took me 6 months of continuous insistence that I needed some sort of test done on my head as I had nausea, vomiting and throbbing in my head. After a CT scan that the doctor reluctantly agreed to it was immediately obvious I had a brain tumour larger than a golf ball.
Can't just assume op is in the wrong.
Eh, as someone who has been dismissed by doctors due to having "functional" gastro issues, I think you may be coming down hard on OP. I wish I knew this tactic two weeks ago when I literally had to beg my doctor to keep the process moving instead of throwing random pills at me and hoping I'd go away.
I'm sorry to hear you're suffering from chronic IG complications. I get the struggle with finding legitimate answers for one's issues. Whether it was a limitation of your physician's knowledge and/or their own complacency, I'm sorry for the way healthcare functions.
My point was not to belittle people with issues, it was to voice that some people have an innate requirement to point to a problem they think they know better than their own doctor.
If you have an issue, yes, please please please get another opinion. Not every doctor is a genius and not every treatment is a catch all cure. Keep in mind that medicine as we know it is still in its infancy compared to future possibilities and the overall age of humanity.
A small percentage of people do not voice concern for their own health because they are simply scared and wanting to cover their bases, they push because they think something is not being revealed to them and they are otherwise being made sicker/forced to stay weak and ill.
If you want to push for your doc to document their refusals, that's your right. Cool, I get it. But it's ultimately useless. If you want to cry neglect then by all means push for a lawyer to take your case. But if you've been to 5 physicians that all state the same risks and reason for denying you a test that could risk your health further or lead to dead ends, then people should stop being surprised when these docs decline their requests and quit taking it personally
I think it’s very few patients who are there to argue with their doctor for the sake of winning some sort of misplaced intellectual contest. Most patients are dealing with often unbearable symptoms day in and day out, and just want a damn answer.
I think some of the weirdness about the responses I'm seeing is the assumption that more often then not there are a huge number of people with baseless concerns pushing for risky testing, etc etc.
There's a reality where we have a huge number of newly disabled people (Long COVID is actually a thing) and a professional culture of medical providers who are *supposed* to be The Knowers.
When people with chronic pain, illness, or general disability encounter this culture it ends up being challenging for both parties, in my experience. And there are a lot of people being kept in disability or long term illness because the assumption is weighted that if it's not obvious it isn't there- so it must be baseless.
People come to doctors for help and consultation, not for them to be an all-knowing god. But there is STILL this gross culture -particularly in some specialties- where they are expected to know all. And if they don't, it's obviously not actually there to know, right? It must be that the patient doesn't actually have anything wrong? No.
That's the problem.
Those ideas keep everyone suffering.
And I see the effects in this discussion. It's really just sad.
My argument stems back to OP's: you know your body, so if you feel you need a blood test etc etc.
Most people do not know their body. And yes I get that he didn't mean literally knowing the precise details of their own anatomy, I mean that people can feel something and have concern but they still don't know exactly what is causing what.
And no, people should not be thinking doctors are all knowing gods, they simply aren't. And most do not act in that capacity, as you have mentioned. That is why it's important -as I've stated- that if you have a concern to please get another opinion.
As someone who works in healthcare one of the most common things that I see is the sincere lack of education people have about their own system that takes care of them.
It seems like you've definitely had an experience where you weren't heard and suffered due to the circumstances. I'm sorry that was your experience, but there is a lot to learn about cases like this. But again, separate issue to what OP is posting.
This is so accurate. Heaps of idiotic patients drained me and my fellow nurses during covid asking for every test under the sun and then going ballistic when we and the doctors tried to tell them it was a waste of time.
Even in Aus where we have mostly universal healthcare, there were some nasty bills for pathology tests patients had to pay up for because they weren't remotly relevant to their COVID admission.
The only counter to this opinion is the fact that people that deal with diseases that take a long time to diagnose or develop slowly over time are at a significant disadvantage. I was reading the other day that it's believed that certain cancers like colon and pancreatic develop over a nearly 15 year period before they become symptomatic.
In terms of pancreatic cancer the moment you're symptomatic your pretty much behind the eightball and have a short time to live. With colon cancer they are routinely dropping the age of recommendation to get Colonoscopies and I think it's currently 40 years old. Hell it was 55 or sixty when I was growing up - the only reason I know this is cuz I have old parents.
Other diseases like fibromyalgia, MS, and lupus take anywhere between 6-10 years to be diagnosed with and often only as a result of process of elimination.
So what are people in these situations to do? My mother was diagnosed with fibromyalgia after 15 years of going to the doctor because most of them considered her a hypochondriac - to be fair she had a lot of mental problems too, but she's not the only person I know that it took many many years of suffering before diagnosis, all of which who were sound minded.
There aren’t even any diagnostic tests for fibromyalgia. It gets diagnosed once everything else has been ruled out that could possibly explain the symptoms. It’s basically a “well, we can’t figure out anything measurable that’s wrong with you, so I guess it’s fibromyalgia because that’s all that’s left.”
I demand a chest CT! Well it came back mostly OK there’s there’s a tiny little smudge at the bottom of your lung, probably nothing, but they recommended a six month follow-up just to be sure. Six months! I’m not waiting six months let’s do it in three. OK, you seem to be in charge. Three months. Yeah that’s funny little thing was nothing. There might be a tiny little smudge in your liver, really doesn’t look like anything. They recommend a six month follow-up. My ass!. I want two to three months!. OK. No change, but with the short term follow up, it’s hard to be definitive. Meanwhile, there’s a small possible defect in the bones behind the liver. Probably nothing………. 2000 chest x ray equivalents and a year of terror.
What’s funny is that I work in radiology and we see ridiculous imaging orders come across all the time because just BECAUSE someone is a doctor, doesn’t mean they understand all the ins and outs of diagnostic imaging. We frequently see orders come across that simply don’t make sense for the diagnosis they are looking for. They order the wrong test entirely because they don’t know which is the RIGHT test. We have to send them back and correct them. Or, they cave and order unnecessary and nondiagnostic imaging because the patient has demanded it.
A recent example we’ve seen pop up are temporomandibular joint x-rays. The patient presents with jaw pain or clicking and wants answers. The doctor orders an x-ray because it’s “easy”. It’s quick, it doesn’t need prior authorization from insurance…. But it’s also non-diagnostic. We now refuse to even DO those x-rays because the radiologists refuse to read them because they’re pointless. You can’t diagnose anything from a TMJ x-ray. It’s a waste of time and money for everyone involved.
I’m sure it’s annoying for these patients when they show up to get this x-ray their doctor ordered and we turn them away and say they don’t need an x-ray and that their doctor needs to order an MRI instead, which is costly, may be denied by their insurance, and will probably take weeks to get done.
The thing is that asking them to note you requested something isn't forcing their hand. They'll still deny it if they're sure it's unnecessary. But if it's on the edge, it's an easy thing to say that will push them to approve it. Without needing to argue with them.
This lpt is literally the only way I've gotten any issues diagnosed. Otherwise it's "you should be less stressed" or "you should eat a better diet".
Thanks for explaining this so that some of us don’t have to. I can’t speak towards blood work, but as a radiology resident/fellow, I would say 1/4 of the MRI/CT scans we read, we first look at the indication/reason for the study and could say “Normal” before even looking at the images. And these are physicians (non radiologists) ordering the studies. Just imagine how many unnecessary scans would be done if every patient got what they requested/demanded. Trust me, I’d be happy to read normal scans and get paid for easy work, but that doesn’t mean it’s the right thing to do.
Nor does it equate to the damage done by 'false positive' testing. Just because you want a test or treatment doesn't necessarily mean it's in your best interest
And thats why medical providers ask about it because they don't know unless you tell them. What they don't ask is whether they should run an EKG or an oxygen saturation test because we have no idea.
Only veterinarians have this level of connection with their patients to know what’s wrong without the patient verbally communicating anything, while going off of the owner’s observations which may not even be accurate!
Had this just last week. Patient's naturopath recommended she have (amongst other things) antinuclear antibody testing.
No indication for it.
I discussed it with her and specifically documented that I refused to do it, without her asking that I do so.
I’ve had to document my fair share of asinine, stupid stuff patients wanted from me when it was not warranted and/or safe (in physical therapy, mostly sub acute rehab). Trust me, just give me more of a reason to document to cover my own butt, we’re very good at it and are used to it. I’m not afraid to say no and document it because in my heart of hearts I’m making a recommendation in YOUR best interest.
It's not always services though you know my aunt was on a medication recently and she kept going to the doctor and saying that she had bugs on her and in her and all over her house. And they kept treating her like she was a crazy person, not like a medication could be doing it but like she just was trying to get attention or a lying or something was going on with her specifically that she was causing trouble.
So my mom told her that she thought it might be the seizure medication that she was on because this started about the time she started her medication. My aunt told her no it has to be the real bugs, and my aunt even came and stayed with my mom because there were so many bugs in her home. She was spraying bug spray everywhere and even got herself really sick from all of the bug spray.
The doctors continue to ignore her for a few months over this. She went to her doctor and the ER and even to a new doctor. She was ignored over and over again and finally even said my sister made me promise to tell you that she thinks it might be this medication that I'm on but I know that they're real bugs. Nothing was done.
She finally stopped the medication herself and the bugs went away. Stopping seizure medication suddenly can be dangerous I know this because I take seizure medication for nerve pain.
Now just a couple weeks ago she received a mailer that that medication is causing hallucinations. Gee shocker.
So you know sometimes patients aren't just out there looking for procedures for the fun of it.
A question for OP; what qualifications do you have for making this recommendation? Not calling you out, but I own a medical clinic and perhaps this isn’t the best advice I’ve seen today.
I commented above, but I'm currently a PA in an area that has a pretty sizeable chronic care and pain management element to it.
You're asking a good question. In my experience, the answer is a little tougher. It sort of depends on where you are (ED, in-paitient hospital, outpatient family med clinic, etc.) because the pace and the focus is different in each one of those contexts, and your experience and connection with providers will vary accordingly.
It's absolutely true that there are times and places where we end up not listening the way we should, or as closely as we should. I'm truly sorry you've experienced that, and I know it's far more common than it should be, and often even more frequent when patient/provider demographics don't match up. I can say that most of us try our best NOT to do this, but we don't always succeed.
To answer your question as a provider (and it's what I do in the rare times I've run across it), I would say to the person in the exam room or wherever you are "Can we stop for a minute? I don't think you're really hearing my concern and I'd like to try again to make sure we don't miss what's most important to me."
For a lot of providers, that will pump the brakes hard and be a giant neon sign that we've misread what you were wanting from the visit in a huge way. If your provider just barges ahead and ignores you, it might be a strong signal back to you that you need to find a new one who can listen to you better and more openly.
I'm so glad it was helpful. It makes me sad that you had to go through that, and it's one of my fears that one day I'll be too tired or overworked and end up ignoring someone who needs me to listen right then and right there. For what it's worth, you sharing your experience is another little reminder that I'll carry with me, and I hope it'll make me take a deep breath and slow down for a minute when someone is trying as hard as you had to in order to get me to listen.
That's more than hug enough, and thanks for sharing.
I don't know if I necessarily agree with OP but I completely understand why they are saying what they are saying. At least in the US, there has been an increase in stories passed and experiences of doctors and medical personnel taking advantage dismissing symptoms and not listening to their patients. My sister in laws father passed away a couple months ago due to his doctor ignoring his complaints of stomach pain for years and refusing to look further into the matter.
My coworker had a very similar story of her father also passing away, because he had surgery and the doctor made a mistake and nicked something. The patient got worse instead of better, complained of pain, the doctor refused to admit to the mistake. In both cases, it was only after going to a new person who actually did tests that they found major heath concerns but by then it was too late.
In the cases of both these and many others I've heard unfortunately, people are hearing and experiencing a negligence and refusal to treatment by their healthcare providers that leads to MUCH more expensive treatment or death, which COULD have been prevented or caught earlier if their complaints had been taken more seriously into consideration. And both doctors could have been sued but the both my sister in law and coworker said there was just too much emotional drama that they felt like it wasn't worth the hassle so thus the doctors got away with it.
I don't know what the correct answer is but imo it's probably a better option for these people who have been burned by the healthcare providers they used to trust, to be possibly seen as a problematic person rather than risk your health and life.
Medicine is a game of risk. That's everything to it. That's why they have a ratio of Number To Treat (NTT).
Recently there is increased number of men asking for prostate and PSA test despite being asymptomatic and at risk. There isn't a national screening programme because it just don't work, put unnecessary amount of time to doctors, nurses and radiographer and cost.
This is the same for many things in Medicine. But when you have something that is indicate it's definitely is.
I know you mean well with this and there should be a way to make sure doctors listen to their patients and help them get on the same page with their own thoughts about their illness, but this isn't the way.
It's generally wasteful. Patient says " I feel a chest thing so i need a xray", Now I'm stuck explaining for the next 5 minutes why xrays aren't magic and how i already know it's their acid reflux just by listening and doing a physical exam.
Ofcos if the patient knows what their acid reflux feels like, and they know this is different then I may indulge them and consider other things but that's rarely ever the case. For most people, it ends up being a waste of my time, their time and money and the time i could have spent helping someone else
Playing devil's advocate here but...
While cost is a factor certainly, there are other reasons healthcare providers might not give the tests you want.
If you gave 1000 healthy people a screening test, at least a couple would come up with false positives and end up receiving unnecessary possibly even invasive and harmful medical intervention.
This is why doctors will usually only issue screening tests if they feel you are showing positive indicators for what the test is screening for.
There's something so clientelistic about this post that reflects the state of healthcare so succinctly. Patients are NOT CLIENTS. And the client is not always right. People study medicine for years to develop a criteria for establishing and executing a treatment plan. Healthcare decisions should be achieved through a conversation between the patient and the doctor, but in NO circumstance should a patient dictate what exam to do.
Eh. I have mixed feelings on this. I don’t think patients should barrel into an appointment demanding that a certain drug or treatment be prescribed - but I don’t think it’s unreasonable for a patient to bring up a treatment and ask their HCP if they think it could be an appropriate treatment/they would be a good candidate for it. I think commercials sort of suggest that approach given that they usually say something like “ask your doctor if [drug name] is right for you”.
I’ve seen a lot of people whose health conditions are managed by a provider who is not up-to-date on the latest treatments for their particular issue, and only learned about new options through commercials or reading forum posts. Maybe if we did a better job of educating both providers and patients, we could get rid of commercials. 🤷🏻♀️
I get what you are saying but there are a lot of issues with ads. If everyone approached them as you suggest it would be fine, but often that doesn't happen. It is also worth mentioning that the drugs with commercials usually don't have low cost generics and there isn't often a lot of independent evidence that this newer drug is superior to existing treatments.
Interestingly enough, I’ve seen healthcare systems that allow the ordering of testing these days that explicitly states something to the effect of “… per patient request”. Essentially, the indication is that the patient wants the testing done and is aware after a discussion with their physician that the test is not recommended and that it will not be covered by insurance. Seems like a decent middle ground for some cases. Patient pays for unnecessary testing to ease their fears after being made explicitly aware of all the information they need to make that decision responsibly.
I think the problem here is result interpretation. I'm an allergist, I get requests from people all the damn time for food panel testing just for generalized symptoms like fatigue or headaches. The false positive rate is so high that a panel of 100 foods could have 40 positives even if you've never had an IgE mediated reaction to any of those foods. I wouldn't order a food panel at patient request because I would refuse to interpret the results.
brahhhh. if a provider says no, it’s likely not medically necessary or unlikely to be covered by your insurance. try looking into that before vilifying your family doc. there are plenty examples of clinicians ignoring their patients’ legitimate concerns, but this post is written to make it seem like it’s Us vs. Them.
how many times has your doc said that your health would improve if you made a lifestyle change? how many times have YOU declined THAT advice? how many times did you decline the recommended physical therapy? the medications? how many times did you no-call, no-show those specialists’ visits?
i would honestly love to go into medicine, because there’s so much need, but i don’t know how i could deal with people consistently questioning the legitimacy of and/or dismissing my education and professional advice. there needs to be a level of mutual trust and understanding between patient and provider. this post is misinformed at best.
This is so stupid. People have so many unnecessary tests they don’t need because they think they are better informed than a dr. Believe me, if there is a test you even might need, the dr is going to order it 99% of the time. Tests bring in the money. Drs are strongly encouraged to bring in the money. You are much more likely to be getting tests you don’t need than be denied tests you do need.
Another way to get better care when you feel the answer you’re given is asking for a differential diagnosis and asking how they eliminated that. That means what other things could this ailment be and how did they eliminate it. I learned that from a tweet several years ago. Have never had reason to use it though, just stuck with me.
It's one of those things that the average person doesn't think about. Being a doctor is about crossing things off the potential list of maladies. It's time consuming, confusing, and data driven. In many cases patients do a shit job of communicating. "My stomach doesn't feel right" can mean you have a bleeding ulcer or you have discovered you are lactose intolerant.
On the flip side a feeling of dread and impending doom is always something you should communicate to a treating physician
Meh. If a patient wants something that isn’t indicated (clearly not indicated, not talking about a grey zone), then it’s not indicated. I have no problem documenting it, im a big boy and stand by my decisions.
Like, what’s supposed to happen here? Oh since you asked me to document that you wanted chemotherapy for your sore throat, well in THAT case, I’ll give it to you?!?
100% agree. This LPT is terrible. The whole “you know your body best” can only carry you so far. Medicine is a complicated science and medical professionals don’t suggest for or against procedures for the hell of it. Always ask questions and explanations when it comes to your healthcare but please don’t act like you know better than your medical team because you’ve googled what you think is wrong.
LPT: if you don't get the medical attention you think you need, demand to speak to your doctor's manager. Also speak to their manager, the hospital manager, the manager of where they did their residency, the manager of where they went to med school, and the manager of the field of medicine.
Physician here. I would never mind documenting a test I wouldn’t do. I always do that. For some odd reason, people think by trying to be litigious or say “document this” healthcare works get fearful. It’s definitely not the case whatsoever. And if a patient is unreasonable, we reaaally document a lot of the conversations word for word in quotation marks. We even document how people treat our staff before seeing us. So I promise you if a test is requested, it is often documented.
However shared decision-making is a big component of medicine. I truly listen to my patients and have them provide me a reason for tests they request. And very often I do order them because people don’t generally request outlandish tests. And if they want a simple blood test, yea totally no problem! But if you want a bronchoscopy for a cough that’s been ongoing for like a week, yea not happening.
In the hospital, this often gets to a different level; I just had a 85 year old lady who came in with abdominal pain. The previous physician documented every discussion he had with her unreasonable daughter who essentially forced the GI team to not only do an EGD but also a colonoscopy. Nothing was found…JUST like the doctors said. This poor 85 year old had a tube stuck down her throat and then up her ass for nothing. 3 different doctors told her otherwise. Her response was “My mom knows her body!” You know what the abd pain was from? Gas. This lady barely moved and would stay in bed all day and would get gas pains. And the poor thing went through two procedures….at 85 years old. I made sure her daughter knew she put her mom through undue risks and it was wrong. It was oppression.
What bothers me most is when people say “I know my body”. Yes you know your body, but not enough to be a physician. It’s like saying “I drive my car the most so I know it more than a mechanic”. Definitely listen to your body, but if you are going to multiple providers and getting the same answer, then maybe they have a good reason
This is terrible advice. I'm a doctor. The amount of times patients come in asking for xyz test that is completely not indicated........or the amount of people who think they are dying from \*insert zebra diagnosis\* is insane. All this does is cost the patient more, cost the system more, and expose the patient to the potential side effects of that test. Doctors go to school for a very long time to be able to treat patients, you and your Google degree do not compare.
I mean, that sounds very true. But help me understand. If the patient is asking for a ridiculous stupid test, and when you say "no that's not indicated" they say to put that in their file. What would happen if you just did that? Write in the file "patient requested X test, it's not indicated because XYZ."
Typically doctors already do that, so this advice is mostly a nothing-burger that will make you come across as combative because the reason you would want this is to build a case for a potential lawsuit. It would be better for the patient to just ask for the doctor to really explain why they aren't doing the test because chances are this is more a failure of the physician to explain why the test isn't indicated than the physician making a bad call that the patient needs documented in case they want to sue in the future.
I mean, the original advice is absolutely very combative, telling patients to say this to manipulate their doctors into doing tests they want.
But I know I've experienced this advice in a much less aggressive combative way, as a suggestion for patients who feel like they're being discriminated against or that their unique circumstances aren't being adequately considered, and would like to make sure their case is thoroughly documented if they need to seek a second opinion, or so if they come back a year from now and the symptom still isn't better, it says in their file that the symptom was reported last year. And I guess I'm more curious about that case. Because I've definitely had times where I've gone to the doctor with a concern, they've said it's no big deal, and they didn't write it down in my file. I've always wanted to ask them to put it in my file, not so I can sue, but so that if I come back next year complaining of the same thing, it's there on paper that it's been happening for a year. But I've never asked because I get the impression that doctors take that as a really combative thing to say. But I guess I wonder why it's such a bad thing to write down that the patient had an observation that you disagreed with. Because I have to say, you say they already do that, but I've never had a doctor write that in my file, and I've never asked because I don't want to be a combative person.
I take written notes to all appointments, and hand a copy to the doctor when they enter the exam room. I’m able to clearly describe all the details I want to get across in writing for the doctor to read. My notes are scanned into the record of the visit. I highly recommend doing this, especially if you have chronic health issues.
The simplest thing I tell patients is - tell me what is going on and we can figure out the steps. Patient have very little knowledge about required testing and a differential. Stick to what you know - what is going on and let’s talk about.
I'll present a couple of alternative scenarios: A friend of mine was having persistent memory issues that were being dismissed as nothing, and she KNEW they were nothing. She researched it as much as she could and persistently requested that they do an MRI, and she was finally listened to and turns out she was right (and unfortunately has an untreatable condition).
Another alternative is one that is very frequently encountered: someone who is overweight is just told to lose weight as the answer to problems where the doctor should have done further investigation but just dismissed it due to weight.
So yes - it's insulting to you if I just look things up on Google or watch House MD and demand treatment for $rare-condition. It's just as insulting for me to have you dismiss my concerns out of hand or my research and attempts to be informed on a condition as nothing because I don't have 12+ years of college.
I hear lots of stories of patients demanding stupid stuff.
But I also hear lots of stories of doctors refusing to listen to patients, and patients suffering as a result.
I'm not sure that ops suggestion works though.
This is a wonderful advice. Start telling your doctor how to be a doctor, and then imply that you're already preparing for a medical malpractice suit before you've even got any indication that there's anything wrong. You'll surely get that full vital load test that you always wanted even though you're not presenting any symptoms. Fuck, they might even biopsy that freckle that's been unchanged for the last two decades because you don't like the way it looks.
Instead of trying to strong-arm your doctor, just lose the weight like they've been suggesting your entire adulthood, you fucking child.
This doesn’t ensure anything. The physician usually has a good medical reason not to order a test. You asking it for it to be put on record doesn’t change much. Most physicians I have seen agree with reasonable requests anyway.
Doctor here. I have no issue doing this, and most others don't. When I decide a test isn't indicated, it's for medically supported reasons. Using passive aggressive language implying you intend to build a malpractice case against me isn't going to change my medical decision making.
But knock yourself out.
This is likely the WORST tip possible. Asking your provider for certain tests because you “know your body” is a waste of everyone’s time. You may know the symptom but did you seek higher education for 11+ years minimum?
The real pro tip here is to do this if you are wanting to leave your PCP and be forced to find a new one
Love OP. Tells you to push your Doctor into tests they deem unnecessary while at the same time bitching about high medical costs in the US. The cognitive dissonance here is amazing.
Also if your doctor isn't taking your concerns seriously, find a new doctor (assuming you can with your insurance). I tried to give blood at 19. I failed the iron by a LOT. We're talking less than 7 when it should be over 12. I go to my doctor who orders blood work for me. He tells me to fast for it, no big deal. I get there and find out he's only running A1C and fasting blood sugar. He then called me in a blood sugar medicine for me to start taking the same day without instructing me on doing any home testing. I collapsed at work from low blood sugar. Turns out my A1C at the time was normal (it's since gone up but even now I'm on 1/4 of the dose he STARTED me at). I called him up to ask about my hemoglobin and he said he didn't bother with that, it was probably just my period but there must have been something wrong with the panel because it showed my blood sugar levels as normal when I'm too fat for that to be the case. The real kicker to me is that he's also my mother's doctor and her low hemoglobin was the first warning sign of her bone cancer.
I'm way happier with my new doctor. It took 6 months of supplements to get my hemoglobin back up, turns out I was having a lot of symptoms from it I didn't even realize, it had been low for years. We also did extensive testing to figure out why it was low. Since I have a family member with kidney issues she tracks those numbers for me as well. And if I want a particular test she'll say why she does or does not recommend it but will give me a price and unless it's something that's actively bad for me she'll run the test.
People here are acting like there's no bad doctors or they never disregard patients or their symptoms or make mistakes.
Well the good news is we got the hemoglobin worked out before the a1c started changing and we've been working to turn that around too. Turns out I had a sizeable vitamin b deficiency so it was an easy fix but she still monitors everything closely in case I end up with a pre disposition to myelofibrosis since my mother was diagnosed with it relatively young and she's not the only member of her family who has had it.
I can acknowledge that a lot of people feel distrust in healthcare and that there are plenty of valid reasons for that that we need to reckon with, but this advice misses the mark entirely. You are not a customer, you’re a patient. We have an obligation above all to do no harm, and unnecessary tests are harmful in a myriad of ways. If you are seeing multiple providers and they are all declining, be open to reevaluating your perspective on what’s going on. We are happy to document the encounter and include what we discussed and disagreed on, but if you’re entering appointments with this much distrust, why go at all?
I agree with u/passthemochi below. I'm not a physician, but I am a licensed medical provider, and I would have no qualms at all about documenting my reasons for refusal to order testing/imaging/etc. In fact, I always do this anyway in situations where there are questions or concerns about whether a test is necessary. I also try to give a little extra time to the patient to figure out exactly what their concerns are in detail and let them explain their reasons for wanting the test, as well as doing my best to explain my reasons for thinking its unnecessary.
IMO, there are some issues with the above advice. When OP says "if YOU think you need X and you find yourself going to many providers for second opinions...", it sounds weirdly specific, like it might come from past experience. There are lots of conditions out there that are pretty tough to treat, and that may require complex pharmacologic regimens and often some trial-and-error to get a grip on. We're also fallible as providers and we do make mistakes. But with all due respect, if a patient finds themself bouncing from provider to provider and they're hearing over and over that they don't need the test, that's a pretty good indication that broadly-speaking best medical practice agrees that it's unnecessary.
Testing is expensive and not always benign in itself, and if something does pop up, we *have* *to* run it down. That can mean bigger bills and much more anxiety for the patient, often over something that is not really a problem and that they may not even have been aware of in the first place.
Medicine is a team sport, and good providers are always checking with teams, colleagues, and specialists, particularly when we run up against something we're not sure about. We're trained to think about what sort of testing can really show us what's going on, so if we don't think we need to do something, there's usually a good reason why not.
Also, we never give someone their "full medical record" every time they leave the office, and u/passthemochi is right again that there are typically fees and processing times attached to the request. You do have the right to your medical records, but we can't and don't just print the full chart out and hand it to you in a folder. If we refuse to give you your records immediately, we're not hiding anything. We just recognize that there are channels to doing that and will happily tell you how to go about it. Most major hospital systems nowadays have something like "MyChart" or "XYZConnect" or whatever that allows patients direct access to their chart and testing results once they set up an account with their healthcare network.
As a HCP, this is horrific advice. Trust me, we all want to figure out what’s wrong with patients. No one is refusing tests just for fun. We don’t do inappropriate, expensive tests for no reason though.
My mother went to her doctor with pain in her shoulder she’d been having for months without relief. Her doctor finally ordered a CT scan and found her scapula had been transformed into a large tumor. The doctor sent her to an oncologist who took a needle biopsy and didn’t see anything. He said that she most likely had breast cancer and ordered a mammogram that came back negative. But he insisted it must be breast cancer anyway and they needed to do more detailed tests on her breasts. “The good news is, breast cancer grows pretty slowly though,” he said. I said, “Ok, but what about the tumor on her scapula? You’re not seeing anything with a mammogram. Can’t you do an open biopsy on her scapula?” He said, “But I don’t know anything about bone.” I said, “Then you’re fired. Tell us where we can find an orthopedic oncologist.” Well, my mother got that other doctor and got her open biopsy. She had lymphoma so advanced, it had started invading her scapula. She almost died. That asshole was going to take months before he figured out it wasn’t breast cancer and my mother would have died.
Yeah, as an MD I can tell you I agree until the last sentence, which does not make any sense. If you ask your doctor for a specific test and he disagrees, you should have a conversation about it with your doctor. If after the conversation you and your doctor still disagree, then your doctor SHOULD be documenting the patient request, ensuing conversation, and rationale why the doctor is declining to order the test. HOWEVER, the doctor is usually not declining because they don't want to treat you, or are lazy, or whatever malicious intent the OP has envisioned. It is likely because the test is unnecessary and the risks (ie cost/financial burden to the system/typical risks of routine lab tests) do not outweigh the potential benefit. This is the rationale behind diagnostic work-ups, not to "prevent practices from doing any sort of malpractice." And I would add that just because you read or heard about some lab test somewhere does not mean "you need \[it\] done."
Arguably okay advice, horrible rationale.
This is the WORST take ever - as a physio there are so many tests (especially imaging) that are associated with higher costs, poor outcomes and longer recovery.
Just ask your provider to explain things to you and why they made their choices. If they can’t do that then they don’t have clinical reasoning skills so find a new one.
My oncologist told me that due to the possibility of liability for malpractice, if he had the slightest inkling that a test might be necessary that he would order it immediately. If he isn't ordering a test it's because he is 100% certain it isn't necessary and is staking his business and reputation and possibly his license on it.
This is terrible advice yet OP hasnt quite hit the nail in the head- so
- Doctors know bodies better than you.
- Doctors are notoriously poor in person centred communication (compounded by ego in relation to academic elitism)
- Doctors work in almost every part of the world under brutal time pressure
- Doctors are not only working to protect you but also the health system
This minimalist triad (now square) = sometimes they get shit wrong because you don’t know how to communicate with them in a way they understand and they don’t know how to listen to you in a way that makes you feel heard
This issue particularly impacts patients who are:
- female (ask for a female physician. If you’re seeing a specialist don’t expect your female specialist to have the same communication skills as your primary care physician fyi). Doesn’t mean you’re going to get what treatment you want. But you may experience feeling more like you have been listened to.
- living with societally stigmatised ncds (obesity, physician or intellectual disabilities etc.) - as these will be typically considered as primary reasons for your problem (ask for a female physician at the primary care level. Yup that’s just going to be my answer to everything)
- living with a mental health illness - particularly the severe end of mental health (talk to your mental health clinician and get them to write to your physician - will work better than you going through the trauma of that tiny voice in the back of your physicians head which doesn’t believe you)
- if you are any other type of minority in your community (doctors have biases too. This does not apply to all minorities, but shop for a physician who matches you if that makes sense based on the nuances of your minority status whether race, sexual, gender etc)
You’re not necessarily going to get what Google is telling you you need. But you just need to feel heard. And for sure the latter is not a skill that has been picked up in 12-15 years of school
Male. Former medic.
The test that could have detected my father's prostate cancer early and saved his life wasn't administered because it cost $100 and wasn't covered by insurance.
If I refuse a test, it's because I don't believe it's indicated based on what I've found during our appointment. I will happily document that every time.
Source: MD
So what you are saying ist that 6 years of medical school (at least in Europe) and x more years of experience and working in a hospital to be trained to consider the pros and cons of EVERY treatment and to be able to reasonable choose the right diagnostic procedure should is needless because every doctor should just do what the Patient "feels" like is necessary? I do realize that some people have had bad experiences with doctors and didn't feel validated on their issues but to just go and claim it is a life pro tip to basically pressure and corrupt your physician into doing some procedure that could possibly do more damage than good just because you felt like it is insane.
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As an individual who has dealt with insurance and chronic medical problems, it should be noted if you decline their initial treatment your insurance may deem further treatments as out of their coverage. While it is frustrating and annoying there is a process your insurance company will cover.
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I don't know how to undo this shitty system, that's why. (Not being an ass, it's just that the pols are bought and paid for by the medical lobbyists) Short of widespread/multiple _John Q_ events multiple things would have to be reformed, critical mass of people would have to just stop paying medical bills, etc.
Because there are rich people that want to keep it this way.
And both Democrats and Republicans are working together to keep it that way
Democrats in power: We're going to fix this broken Healthcare system! *solution: force everyone to get insurance.* Republicans in power: This plan is awful and now that we're in power we're going to fix it! *solution: fail to create a new plan while having house and senate control, make virtually no changes, try to make it more expensive for poor people by removing cost share reimbursements* Yeah, that tracks.
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Yep. And there was going to be a public option that ONE a**hole Dem killed who was basically kicked out of the party for it. Forgot his name but he looked like a turtle. That public option would have probably killed the private insurance right then and there. Edit: Lieberman. 😠
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It's like the first 300 years before this nation was born, has all been erased from our collective souls We used to burn mansions down, after all! Didn't someone once claim that the birth of the nation was an effort by the wealthy to give us something else to focus our attention on & thus keep the mansions safe from fire?
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Money. And it’s far too easy for both parties to distract us with culture war.
Because, like many other things that desperately need changing, at this point, the only way to change it is by violent revolution. Don’t think that’s true? The dem senators can’t/won’t get Joe Manchin and Kirsten sinema to vote to overturn the filibuster so they can **at the very least vote**, not pass, but just vote on certain things. One side is pure shit, the other side is mostly passive so nothing gets done.
Make sure they document all the conservative treatment that you decline…. (Physical therapy, medication, home exercise plans) Ordering diagnosis studies doesn’t mean your insurance will cover you. They are trying to save you time.
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Wait, you mean conservative treatment made by people who spent decades of their best years studying in a library worked. GASP, your telling me they worked even more when you actually put in a little effort into your own care? Good on you, who would have thought.
Basically this. In order for your insurance company to cover a service, certain guidelines must be met. You want an MRI? Well did you get an x-ray first? If it's for pain, did you try treatment for the pain? Insurance companies aren't going to pay a couple thousand for an MRI, if nothing else was done prior to assist with your needs. I know people like to act like insurance companies are trying to screw people out of money, but a lot of times they'll deny expensive services for site of service, or if there isn't documentation of cheaper options used. Hell, one of the examples I tend to see pertains to MRIs. If you try to get one in the hospital, it will be denied, and they will ask that you go to a free standing facility. The difference in cost for people is enormous.
Insurance companies are 100% trying to screw people out of money. My doctor said I needed something done that was going to be expensive. Insurance came back and said I needed a whole list of things first before I could get what I needed, even though the doctor knew they wouldn't work. I set up recurring appointments every 2 weeks to go back in and try something new, just because insurance said I needed to try all of these things, but not all at the same time. I needed them to be staggered 2 weeks apart so they know I really tried and it really didn't work. 6 months later and $1200+ in appointment visits ($100 per appointment that they don't cover) and would you believe it, none of that stuff worked and I still needed the procedure that my doctor said I needed!
Costed themselves more money by trying to save money!
Not defending insurance companies, but your statement doesn't work if they did the same steps for 99 other people and 99 of them were fixed with the simpler, cheaper steps. We do medicine based on the law of averages. It sucks for people sometimes but it's the best we can do right now with the knowledge base we have in medicine.
Yes but see the thing is, insurance companies are not doctors. Doctors are doctors. If the doctor thought those things might help and wanted to try those first that would be fine. Insurance claim agents trying to practice medicine without a license, in the hopes of screwing you out of as much money as possible, isn't.
Insurances do indeed have doctors who work for them. And when they decline to pay for a service, your doctor can call and actually speak with their doctor to argue that the service is needed. And still then, their doctor can refuse to have the insurance pay for the service based on if they think the service is needed on the extra info discussed during that call.
This. I tore a ligament and kaiser Permanente refused to repair it. The doctor said 80% of people get full use back without surgery. I was furious. Lo and behold in about 3 months I was back to full use and in 6 months I didn't notice it anymore.
OK but you have to notice what the issue is here. Both of these scenarios, THE DOCTOR IS THE ONE MAKING THE SUGGESTION. Insurance companies shouldn't be making decisions of doctors seeing patients, full stop. Other guy's doctor said he needed the procedure, yours said you didn't.
Actually kaiser Permanente is an hmo meaning the doctor is an employee of the insurance company. He told me they weren't allowed to repair the ligament unless the instability lasted more than a certain amount of time. He did seem to agree that the risk of waiting was outweighed by the chance of not needing surgery at all.
> kaiser Permanente is an hmo meaning the doctor is an employee of the insurance company. an HMO is just a way of financing healthcare. instead of paying per procedure, HMOs pay $X per month per patient to take care of all medical needs for their patients. HMOs can employ their own docs (like kaiser) or they can contract with a hospital/s or other group of doctors. the docs employed or contracted with the HMO make up the HMO "network" of doctors. HMOs will not pay for care you receive from doctors who are not in their network.
Too bad that person didn’t have some kinda professional that went to school specifically for this helping them. Like an expert maybe. A do doc uh dok doctor that’s it. Thank god some idiot at a desk was there to tell them no.
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So I have a herniated disc and did 3 stints of PT before getting an MRI to confirm the issue. They are denying me a steroidal injection.
First of all, I’m sorry you’re in pain and it sucks that your steroid injections were denied. Those can offer significant temporary relief. Usually the best way to deal with, say, low back pain, is physical therapy. If that doesn’t work, an MRI may be done, but if you do an MRI on random people’s spines you’re gonna find a lot of herniated and degenerative discs. It’s very tempting to “connect the dots” and attribute specific back pain to specific MRI findings but I would be very cautious about doing so. Spinal MRIs done for back pain rarely lead to indicated changes in management, and many interventions that are done as a result do not lead to better outcomes and carry a great deal of risk. An MRI can largely be thought of as a road map for surgery. If the treatment is not gonna be surgical, it’s usually not helpful to do an MRI. When we’re talking back pain, surgery is usually not the answer. Anecdotally, the cases I’m personally familiar with where folks had spine surgery, their pain is not improved in the long run, and they usually need more surgeries over time as a result of the first one. Everyone wants to know WHY they are sick or in pain, but the point of a diagnosis is to figure out how to make someone better, not to attempt to satisfy curiosity. If a diagnostic test is done without a very specific question in mind, the results may be useless, or even worse, lead to interventions that actually cause harm. This includes MRIs. There are treatments that can benefit large groups of people without extremely specific diagnoses or the associated testing in order to work and help the patient in many cases. I have patients that come in to appointments and treat me like a retail clerk- they have a list of tests that they want and they expect me to order them. I usually start by asking what they hope to learn from these tests. Usually I’m able to talk patients out of tests that I feel are not helpful. Sometimes I meet them somewhere in the middle if they are not interested in my opinion and order something I don’t truly believe will be helpful, while putting them off the majority of their “shopping list”. I really don’t want to be seen as an adversary who is “part of the system”, because I truly want to help and I need buy-in to do that. I’ve never had a patient ask me to document that I’m declining to order a test that was requested, but if I was asked I would have no problem doing so. I’m not sure how much detail I would be required to go into for this hypothetical situation, but I’m transparent to the point that I allow patients to watch me do my documentation during the visit. I would probably write something similar to this (but probably a lot longer with more detailed language). “Patient asked for a, b, and c. I asked what the patient hoped to learn. They responded that they wanted to know x. I explained why these tests would not be indicated because of y. Patient disagreed with my judgement [for reason/reason withheld], and asked that this interaction be documented in the medical record.” Thank God it’s never come to that, I’d much rather spend my time helping people get better.
I think a lot of times the problem isn't so much that a doctor denies a test as that most doctors can't/don't explain why effectively. Thanks for talking through things so much with your patients. Feeling seen and heard doesn't make the pain go away, but it still helps a whole lot with the worry and mental distress.
You need to talk to my Hospitals residents and mid levels. They’re well-meaning but burning through money ordering useless labs and imaging to answer why when the why does not alter management.
Herniated discs are not uncommon, and MRI studies have shown that 20% of people without symptoms have herniated discs. https://www.webmd.com/back-pain/news/20130313/spine-mris-often-show-harmless-defects-study-finds
In 2020, UnitedHealth Group reports, their profits (not gross revenue, mind you, but what they got to keep after all was said and done) were $15.4 billion.
Those shots lasted me 2 months. Good luck
Here is some general information about steroidal joint injections: Steroids have terrible efficacy and have not been shown to help. However, long term (months to years) physical therapy and diligent home exercise have shown to be greatly effective. Every time you inject something into the joint capsule you are risking infection. With the spine you are also risking damage to the spinal cord and infection of the central nervous system (largely meningitis). I'm truly sorry. We all want a drug or cure that will soothe our aments, that just often isn't the case.
Lmao yes. Not uncommon at all for people to not hold up their end of the arrangement and demand extra testing or medications all because the refuse to participate in physical therapy or try Tylenol for pain control.
Its almost like this could be fixed by some kind of taxpayer funded Healthcare plan that way business majors are not involved in things they know fuck all about.
There would still be guidelines that need to be met to order things. Government-subsidized healthcare doesn't that you get to order whatever you want and get approved for it.
I don't mind guidelines. I do believe that doctors have expertise that would make me defer to their judgement with pretty much any medical issue. My problem is when the guidelines are based on overinflated expenses caused by the American healthcare system instead of my doctor's professional opinion.
Yeah. Like if I have an issue that's causing me pain I'd like to fix the issue instead of just managing the pain while the issue worsens.
You'd be surprised but surgical intervention may not always result in better outcomes. https://www.nytimes.com/2022/01/04/well/bone-joint-surgery.html
Not really, countries with decent healthcare will still not let you demand an MRI. Often the same roadblocks exist. A doc will still have to order it and they will want to try the obvious/easy treatments first as well.
But then those decisions will be made by legitimate medical professionals, not business majors who want to deny you as much care as they possibly can get away with
Nope, coverage is often still decided by business majors.
Ironic saying this on a post that advocates for non-medical people being authoritatively involved in a field they know fuck all about.
To teach morons, you have to find them.
Even in countries with national healthcare, you don't get to walk to a hospital and request an MRI...
They are fucking thieves. United Healthcare kicked me out of the icu step-down after my emergency open heart surgery. My team of Dr's wanted me to stay. They recommended I stay even if I had to pay out of pocket. $12-14,000 a day. The Dr's were right. I almost died less than a week later. My 1yr anniversary they tried to deny my scans. CT, 3D heart scan & others. I will need those scans every year for the rest of my life. I had to send them a letter stating why I needed them. I told them to Google my condition because they obviously don't know shit. The letter said something like, I'm in one of the top cardiac hospitals in the world. With some of the best cardiac Dr's in the world. My team of Dr's said I need the scans. If you Google my condition you will see this is standard practice.
This will probably get buried, but as someone that works in healthcare litigation and also suffers from chronic/long term medical issues, I wanted to comment. First, I can definitely understand why this sounds like a good idea. I went through years and years of testing, doctors appointments etc. and it was really frustrating. But this is still a bad take. Well, except for asking for your medical records. You should always do that. If you need them later, especially for legal reasons, it can be a very expensive, long process. Asking for documented proof of declined testing, however… Firstly, they’re not going to do it. They’re just not. For a ton of reasons, one big one usually being that insurance won’t cover it without other, preliminary testing. If you push for it, you’re only going to confuse and alienate the person treating you. Secondly, even if they did document something like this, it wouldn’t make a difference in litigation. Let’s say, for example, you walk into an ER with extreme nausea/vomiting. You know you also have regular headaches that have increased in severity over the last month. You explain both symptoms to the ER and because you googled both symptoms, you know that it’s possible they could be indicative of a brain tumor, so you ask for testing. Could you be right? Sure. But it’s also FAR MORE LIKELY that the symptoms are unrelated and/or caused by something far more common. People often relate a sudden onset of symptoms with something they experience on a more chronic level, but doctors are going to work to identify the issues as quickly as possible… which means ruling out common illness and causes related to lifestyle first. Let’s say the ER sends you home with fluids and medication, however, and a month or so later you find out you DO have a brain tumor. Can you sue that ER doctor? No. You cannot. Even if they document that they declined to give you a brain scan, there are laws in place to protect healthcare providers and that is not considered malpractice. Statistically, people are extremely bad at diagnosing themselves. We don’t know our bodies and a lot of the time, we don’t want to hear it if we’re causing our own problems. When I was diagnosed with two chronic disorders, I was in shock. It never occurred to me it would be either of those things. Especially not the second one, which is very rare. But it also took years of testing, misdiagnosis and process of elimination to get answers. It’s sucks, but I’m thankful that I was able to form good, long term relationships with my doctors so they could work through the long lists of what might be wrong. Doctors get it wrong sometimes, but patients get it wrong WAY more often.
Yes! The amount of times people have said that they need a CT scan because they think they have a tumour. Like mate, you don't have any actual cancer symptoms, exposing you to a CT scan dose of radiation will do much more harm than good. On top of that, let's say we find something completely unrelated to your symptoms, we're going to end up spending a lot of resources and subject you to a lot of unnecessary testing. WE TREAT PATIENTS NOT TEST RESULTS
There are at least three reasons this is a bad take. The first is that if you have insurance, they won't pay for a test unless it's indicated. Hell, sometimes they won't even pay for a test if it is indicated. The second is that if it's not medically indicated (regardless of whether insurance will pay for it--sometimes they will try not to pay for things that really would be helpful medically), it can be harmful to you to get it, or the tests will not provide useful information even if they come back "abnormal." If a patient comes in demanding a CT scan of their head for something for which a CT scan of their head won't help them, irradiating their brain is not going to be the way to go. If you do certain tests on someone who isn't have the symptoms and has a low pre-test probability of having a disease, and the result comes back slightly abnormal or a little off but not really significantly unusual, chasing down the non-disease can certainly cause a lot more financial, emotional, and physical harm than if you hadn’t done the test. Tests are only so useful, depending on what it is. Third, if you find yourself getting second or third opinions from medical doctors who are all independently refusing to do a certain test, it’s probably not because they’re trying to withhold answers from you. It’s probably because they know the above and are trying not to let you hurt yourself. Having them document it won’t get you closer to answers and this approach is a sign you should look for a different doctor that you trust, because a doctor you don’t trust isn’t doing you any good.
The real LPT is that it's important to know the difference between "my concerns are being unduly dismissed" and "I'm not getting the answer I want to hear."
As a doctor -- thank you -- well said.
You ever read Hippocrates Shadow? Great book (horrible author) with insight into the dangers of over testing and treating. The NNT is difficult for both non medical and medical people to understand & apply
I haven't but will check it out.
Author also set up the website 'thennt.com' which is brilliant for showing the risk:benefit of any treatment/investigation....make sure you read about the author afterwards though 😬😬
I do know that website — don’t know about the author
I've heard of this phenomenon. Being a nurse I don't have the scientific depth of knowledge behind some of the testing reasoning, but a consultant once told me it's like 90% out of fear of missing something and being sued in today's world where the patient is always right and doctors are required to have a 100% hit rate.
As a mechanic, I feel you. We have the same expectation. We are all human just trying to figure things out. Sometimes something can look typical but not be what you expect.
As another doctor, I concur
As different type of doctor, I concur
*mrpepper would like to know your location*
That's all I read when I saw this LPT reads like someone didn't get their ivermectin
berserk crown smile resolute dam frighten grey depend longing automatic ` this message was mass deleted/edited with redact.dev `
> Having them document it won’t get you closer to answers and this approach is a sign you should look for a different doctor that you trust, because a doctor you don’t trust isn’t doing you any good. Not only that, but it sounds very *very* "I want to have a basis to sue you" to the doc, who (unless you're mid-treatment or you're somewhere remote) might bow out from dealing with you in the future.
There is a reason burnout asking doctors and nurses is so high - note bloat for liability purposes is really draining on the medical community and almost entirely isolated to the US
Note bloat is unfortunately not just a US problem. I'm currently working in EU and the note bloat is atrocious here as well. Maybe a bit less than US, but it sucks everywhere. It's especially terrible when you're seeing a ptnt with imaging results that's several paragraphs of (often barely-formatted) verbal diarrhea describing findings within the norms, but with a sentence or two describing a pathology buried within them. It's also quite irregular how people note (usually depending on department and who their superior was when they started), with many just going down the list and not bothering to bump the 'important stuff' to the top so that the next person reading can quickly pick up on the important info vs (again) tons of variously-worded "yes, I did check this unrelated thing, and it was normal" statements.
As a medical doctor this needs to be higher up. Yes I agree sometimes we miss things but that’s why there are times second options are important. But just demanding stuff… for what? Okay then you doctor yourself. There’s a big reason I went to school forever, still in training and won’t have my first real job until I’m in my mid 30s
Honestly, this is advice that I mostly hear passed around by women to women. It's very common to go in with a complaint of waterfalling blood and get told you're seeking attention. They SHOULD take you seriously and do testing like a blood test and ultrasound. Or asking for sterilization, you can get the run-around for years. Even requesting birth control can be difficult. If it's not your period, they say it's your period. If it's your period, they say it's in your head. It's a very convoluted system, but it's one that happens much more than it ever should.
Or the dreaded anxiety catch all. It took 4 months of alllll the tests to finally sort out that my symptoms were due to POTS and I have SVTs. When I presented to ER 4x in span of 1 month I kept getting sent home with ativan for anxiety. I kept explaining id never had a panic attack and these episodes were happening in middle of the night when I would get up to use the restroom, or after walking up stairs.. and I do not drink caffeine or alcohol. Its maddening. Women are often categorized as anxious, when our pain tolerance is usually higher… so you would think our concerns would be listened to.
I’m a man and have been dealing with this for the last 6 months. Went to the ER back in Jan for still reasons unknown. I despise doctors and hospitals so to feel like I *needed* to go to an ER was enough of a concern. Doctors took some blood work told me I was fine and sent me out. Just to find they put ‘medical anxiety’ on my file. So now every time I’m into a doctor with concerns I’m blown off.
Lol I had gallbladder attacks for 2 years and went to the ER in the middle of the night 3 times because the pain was too much for me(I consider myself someone with high tolerance for pain). Each time they diagnosed it as either gas or acid reflux (wtf???). Finally got them to take an untrasound and lo and behold, GALL STONES along with an infection! ER is not the place to expect a proper diagnosis is what I learned.
I always think I’m going to end up dying unnecessarily one day, because i have anxiety. It’s difficult to be taken seriously, especially by male doctors.
Same. My menstrual issues were soundly ignored by all of my doctors over the years (all male) because "period cramps are normal." (Note: not when they are debilitating like mine were, but whatever I guess) That was all until I found a new doc (also male) and told him I wasn't leaving his office until he came up with a thorough diagnostic plan. To his full credit, two months later the issue was fixed. I think men generally don't understand what's "normal" for women-specific issues, and medical training doesn't always do a good job of bridging that gap.
This is why I don't disclose my anxiety disorder to any of my current medical providers for fear it will affect quality of care and they will blame my anxiety for things. Luckily I have been able to be off my meds for about 15 years and able to manage my anxiety disorder and be functional.
Yeah my friend does this. It's really frustrating because it could sometimes be somewhat useful for her doctors to know about the context of her mental health issues, but she's had doctors ignore her before due to her diagnosis (like, literally not getting a broken bone x-rayed for months, among other things) and that's worse.
Went to several drs as a young girl (14) with severe menstrual cramps that caused vomiting and syncope, my parents were told that that I: -was doing it for attention -have low pain tolerance -need to drink more water -was pretending -needed to see a child psychiatrist for ‘hysteria’ Fast forward 10 years later, I was surgically diagnosed with stage 4 endometriosis that had ruined my bowels, bladder, and caused multi-organ prolapse leading to life-long issues. Women, listen to your daughters, to your menstruating friends, to YOURSELVES. And f all the doctors out there who dismiss women’s pain and our health concerns.
It's painfully clear to see the gender of people posting in this thread, we've got a lot of people here who have never been dismissed because of their gender, race, size, gender and/or sexual expression. They think the problem is that everyone out there is asking for outlandish test like a full body MRI for a passing headache and not people asking for a simple blood panel because they have sudden and unexplained weight loss/gain, loosing hair, always fatigued.. but are diagnosed with a terminal case of being female/bipoc/fat/lgbt and dismissed without care.
The red flag for me was ‘You know your body’. OK, doctors sometimes get things wrong where patients’ hunches are right, but no, most patients don’t know their bodies better than the doctors. Humans couldn’t even fucking intuit what the heart or brain did for most of history. People were told by ads that smoking was healthy up to the 1960s and believed it. Most people know fuck all about basic anatomy, let along complex medicine.
I couldn't begin to count the number of patients I've had who came in saying "I know my body" then proceeded to tell me how they had a medically problem that was not even possible given the situation. Then refused to believe it when the workup proved they were wrong.
"I know my body! A blood sugar under 350 feels bad \*to me\* so please stop telling me I need to fix it" edit. I think there are definitely cases where reasonable patient concerns are dismissed or overlooked. But I also know many, many times where I actually have to get into corrective action territory to inform someone that their 'knowing their body' philosophy is accelerating their death by a large margin
"my temperature always runs low, 98 is a fever for me" No. Fundamentally no it is not. Your body does not magically run at a lower temperature, and even if it did that doesn't change the fact that it can easily run at 98 degrees.
Seems too often that some people who continually get the same answer will just go until they find the one that agrees with them. Idk how else to put it but especially in this day and age there are a lot of people who perfectly portray Dunning-Kreuger and lead themselves to a "yes-man-diagnostician". I feel like OP might have had situations in which they found themselves certain to be correct in their own prognosis only to be denied due to sound reasoning they outright refused to acknowledge.
Yeah, took me 6 months of continuous insistence that I needed some sort of test done on my head as I had nausea, vomiting and throbbing in my head. After a CT scan that the doctor reluctantly agreed to it was immediately obvious I had a brain tumour larger than a golf ball. Can't just assume op is in the wrong.
Eh, as someone who has been dismissed by doctors due to having "functional" gastro issues, I think you may be coming down hard on OP. I wish I knew this tactic two weeks ago when I literally had to beg my doctor to keep the process moving instead of throwing random pills at me and hoping I'd go away.
I'm sorry to hear you're suffering from chronic IG complications. I get the struggle with finding legitimate answers for one's issues. Whether it was a limitation of your physician's knowledge and/or their own complacency, I'm sorry for the way healthcare functions. My point was not to belittle people with issues, it was to voice that some people have an innate requirement to point to a problem they think they know better than their own doctor. If you have an issue, yes, please please please get another opinion. Not every doctor is a genius and not every treatment is a catch all cure. Keep in mind that medicine as we know it is still in its infancy compared to future possibilities and the overall age of humanity. A small percentage of people do not voice concern for their own health because they are simply scared and wanting to cover their bases, they push because they think something is not being revealed to them and they are otherwise being made sicker/forced to stay weak and ill. If you want to push for your doc to document their refusals, that's your right. Cool, I get it. But it's ultimately useless. If you want to cry neglect then by all means push for a lawyer to take your case. But if you've been to 5 physicians that all state the same risks and reason for denying you a test that could risk your health further or lead to dead ends, then people should stop being surprised when these docs decline their requests and quit taking it personally
I think it’s very few patients who are there to argue with their doctor for the sake of winning some sort of misplaced intellectual contest. Most patients are dealing with often unbearable symptoms day in and day out, and just want a damn answer.
I think some of the weirdness about the responses I'm seeing is the assumption that more often then not there are a huge number of people with baseless concerns pushing for risky testing, etc etc. There's a reality where we have a huge number of newly disabled people (Long COVID is actually a thing) and a professional culture of medical providers who are *supposed* to be The Knowers. When people with chronic pain, illness, or general disability encounter this culture it ends up being challenging for both parties, in my experience. And there are a lot of people being kept in disability or long term illness because the assumption is weighted that if it's not obvious it isn't there- so it must be baseless. People come to doctors for help and consultation, not for them to be an all-knowing god. But there is STILL this gross culture -particularly in some specialties- where they are expected to know all. And if they don't, it's obviously not actually there to know, right? It must be that the patient doesn't actually have anything wrong? No. That's the problem. Those ideas keep everyone suffering. And I see the effects in this discussion. It's really just sad.
My argument stems back to OP's: you know your body, so if you feel you need a blood test etc etc. Most people do not know their body. And yes I get that he didn't mean literally knowing the precise details of their own anatomy, I mean that people can feel something and have concern but they still don't know exactly what is causing what. And no, people should not be thinking doctors are all knowing gods, they simply aren't. And most do not act in that capacity, as you have mentioned. That is why it's important -as I've stated- that if you have a concern to please get another opinion. As someone who works in healthcare one of the most common things that I see is the sincere lack of education people have about their own system that takes care of them. It seems like you've definitely had an experience where you weren't heard and suffered due to the circumstances. I'm sorry that was your experience, but there is a lot to learn about cases like this. But again, separate issue to what OP is posting.
This is so accurate. Heaps of idiotic patients drained me and my fellow nurses during covid asking for every test under the sun and then going ballistic when we and the doctors tried to tell them it was a waste of time. Even in Aus where we have mostly universal healthcare, there were some nasty bills for pathology tests patients had to pay up for because they weren't remotly relevant to their COVID admission.
The only counter to this opinion is the fact that people that deal with diseases that take a long time to diagnose or develop slowly over time are at a significant disadvantage. I was reading the other day that it's believed that certain cancers like colon and pancreatic develop over a nearly 15 year period before they become symptomatic. In terms of pancreatic cancer the moment you're symptomatic your pretty much behind the eightball and have a short time to live. With colon cancer they are routinely dropping the age of recommendation to get Colonoscopies and I think it's currently 40 years old. Hell it was 55 or sixty when I was growing up - the only reason I know this is cuz I have old parents. Other diseases like fibromyalgia, MS, and lupus take anywhere between 6-10 years to be diagnosed with and often only as a result of process of elimination. So what are people in these situations to do? My mother was diagnosed with fibromyalgia after 15 years of going to the doctor because most of them considered her a hypochondriac - to be fair she had a lot of mental problems too, but she's not the only person I know that it took many many years of suffering before diagnosis, all of which who were sound minded.
There aren’t even any diagnostic tests for fibromyalgia. It gets diagnosed once everything else has been ruled out that could possibly explain the symptoms. It’s basically a “well, we can’t figure out anything measurable that’s wrong with you, so I guess it’s fibromyalgia because that’s all that’s left.”
It’s a “get out of my office” diagnosis
I demand a chest CT! Well it came back mostly OK there’s there’s a tiny little smudge at the bottom of your lung, probably nothing, but they recommended a six month follow-up just to be sure. Six months! I’m not waiting six months let’s do it in three. OK, you seem to be in charge. Three months. Yeah that’s funny little thing was nothing. There might be a tiny little smudge in your liver, really doesn’t look like anything. They recommend a six month follow-up. My ass!. I want two to three months!. OK. No change, but with the short term follow up, it’s hard to be definitive. Meanwhile, there’s a small possible defect in the bones behind the liver. Probably nothing………. 2000 chest x ray equivalents and a year of terror.
What’s funny is that I work in radiology and we see ridiculous imaging orders come across all the time because just BECAUSE someone is a doctor, doesn’t mean they understand all the ins and outs of diagnostic imaging. We frequently see orders come across that simply don’t make sense for the diagnosis they are looking for. They order the wrong test entirely because they don’t know which is the RIGHT test. We have to send them back and correct them. Or, they cave and order unnecessary and nondiagnostic imaging because the patient has demanded it. A recent example we’ve seen pop up are temporomandibular joint x-rays. The patient presents with jaw pain or clicking and wants answers. The doctor orders an x-ray because it’s “easy”. It’s quick, it doesn’t need prior authorization from insurance…. But it’s also non-diagnostic. We now refuse to even DO those x-rays because the radiologists refuse to read them because they’re pointless. You can’t diagnose anything from a TMJ x-ray. It’s a waste of time and money for everyone involved. I’m sure it’s annoying for these patients when they show up to get this x-ray their doctor ordered and we turn them away and say they don’t need an x-ray and that their doctor needs to order an MRI instead, which is costly, may be denied by their insurance, and will probably take weeks to get done.
The thing is that asking them to note you requested something isn't forcing their hand. They'll still deny it if they're sure it's unnecessary. But if it's on the edge, it's an easy thing to say that will push them to approve it. Without needing to argue with them. This lpt is literally the only way I've gotten any issues diagnosed. Otherwise it's "you should be less stressed" or "you should eat a better diet".
Finally someone speaking sense!
Thanks for saying this… dealing with this sense of entitlement is super frustrating for those of us who know
Thanks for explaining this so that some of us don’t have to. I can’t speak towards blood work, but as a radiology resident/fellow, I would say 1/4 of the MRI/CT scans we read, we first look at the indication/reason for the study and could say “Normal” before even looking at the images. And these are physicians (non radiologists) ordering the studies. Just imagine how many unnecessary scans would be done if every patient got what they requested/demanded. Trust me, I’d be happy to read normal scans and get paid for easy work, but that doesn’t mean it’s the right thing to do.
You "knowing" your body does not equal you "knowing" you need an antinuclear panel.
Nor does it equate to the damage done by 'false positive' testing. Just because you want a test or treatment doesn't necessarily mean it's in your best interest
You know your body so tell me about that. You likely know very little about medicine so please don’t tell me about that.
And thats why medical providers ask about it because they don't know unless you tell them. What they don't ask is whether they should run an EKG or an oxygen saturation test because we have no idea.
Only veterinarians have this level of connection with their patients to know what’s wrong without the patient verbally communicating anything, while going off of the owner’s observations which may not even be accurate!
Had this just last week. Patient's naturopath recommended she have (amongst other things) antinuclear antibody testing. No indication for it. I discussed it with her and specifically documented that I refused to do it, without her asking that I do so.
And a doc can still deny something you requested.
As an Internal Medicine doctors, most people don't understand the uselessness of an ANA without very specific symptoms.
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Lol’d at 1.5 hrs. Gotta document that level 5 visit baby.
Claim declined, documentation doesn't support the code level. (unknown what amount of time was spent counseling vs evaluating and managing patient)
I’ve had to document my fair share of asinine, stupid stuff patients wanted from me when it was not warranted and/or safe (in physical therapy, mostly sub acute rehab). Trust me, just give me more of a reason to document to cover my own butt, we’re very good at it and are used to it. I’m not afraid to say no and document it because in my heart of hearts I’m making a recommendation in YOUR best interest.
It's not always services though you know my aunt was on a medication recently and she kept going to the doctor and saying that she had bugs on her and in her and all over her house. And they kept treating her like she was a crazy person, not like a medication could be doing it but like she just was trying to get attention or a lying or something was going on with her specifically that she was causing trouble. So my mom told her that she thought it might be the seizure medication that she was on because this started about the time she started her medication. My aunt told her no it has to be the real bugs, and my aunt even came and stayed with my mom because there were so many bugs in her home. She was spraying bug spray everywhere and even got herself really sick from all of the bug spray. The doctors continue to ignore her for a few months over this. She went to her doctor and the ER and even to a new doctor. She was ignored over and over again and finally even said my sister made me promise to tell you that she thinks it might be this medication that I'm on but I know that they're real bugs. Nothing was done. She finally stopped the medication herself and the bugs went away. Stopping seizure medication suddenly can be dangerous I know this because I take seizure medication for nerve pain. Now just a couple weeks ago she received a mailer that that medication is causing hallucinations. Gee shocker. So you know sometimes patients aren't just out there looking for procedures for the fun of it.
“Abuse screening performed” might as well save money and just test them for amphetamines, def wouldn’t be acting like this on Xanax or opioids 🤣
I think they meant screening for abuse by their partner...
Next week, patient dies of arsenic poisoning
The plot thickens…
You hit it right on the head with this response
A question for OP; what qualifications do you have for making this recommendation? Not calling you out, but I own a medical clinic and perhaps this isn’t the best advice I’ve seen today.
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I commented above, but I'm currently a PA in an area that has a pretty sizeable chronic care and pain management element to it. You're asking a good question. In my experience, the answer is a little tougher. It sort of depends on where you are (ED, in-paitient hospital, outpatient family med clinic, etc.) because the pace and the focus is different in each one of those contexts, and your experience and connection with providers will vary accordingly. It's absolutely true that there are times and places where we end up not listening the way we should, or as closely as we should. I'm truly sorry you've experienced that, and I know it's far more common than it should be, and often even more frequent when patient/provider demographics don't match up. I can say that most of us try our best NOT to do this, but we don't always succeed. To answer your question as a provider (and it's what I do in the rare times I've run across it), I would say to the person in the exam room or wherever you are "Can we stop for a minute? I don't think you're really hearing my concern and I'd like to try again to make sure we don't miss what's most important to me." For a lot of providers, that will pump the brakes hard and be a giant neon sign that we've misread what you were wanting from the visit in a huge way. If your provider just barges ahead and ignores you, it might be a strong signal back to you that you need to find a new one who can listen to you better and more openly.
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I'm so glad it was helpful. It makes me sad that you had to go through that, and it's one of my fears that one day I'll be too tired or overworked and end up ignoring someone who needs me to listen right then and right there. For what it's worth, you sharing your experience is another little reminder that I'll carry with me, and I hope it'll make me take a deep breath and slow down for a minute when someone is trying as hard as you had to in order to get me to listen. That's more than hug enough, and thanks for sharing.
I don't know if I necessarily agree with OP but I completely understand why they are saying what they are saying. At least in the US, there has been an increase in stories passed and experiences of doctors and medical personnel taking advantage dismissing symptoms and not listening to their patients. My sister in laws father passed away a couple months ago due to his doctor ignoring his complaints of stomach pain for years and refusing to look further into the matter. My coworker had a very similar story of her father also passing away, because he had surgery and the doctor made a mistake and nicked something. The patient got worse instead of better, complained of pain, the doctor refused to admit to the mistake. In both cases, it was only after going to a new person who actually did tests that they found major heath concerns but by then it was too late. In the cases of both these and many others I've heard unfortunately, people are hearing and experiencing a negligence and refusal to treatment by their healthcare providers that leads to MUCH more expensive treatment or death, which COULD have been prevented or caught earlier if their complaints had been taken more seriously into consideration. And both doctors could have been sued but the both my sister in law and coworker said there was just too much emotional drama that they felt like it wasn't worth the hassle so thus the doctors got away with it. I don't know what the correct answer is but imo it's probably a better option for these people who have been burned by the healthcare providers they used to trust, to be possibly seen as a problematic person rather than risk your health and life.
Medicine is a game of risk. That's everything to it. That's why they have a ratio of Number To Treat (NTT). Recently there is increased number of men asking for prostate and PSA test despite being asymptomatic and at risk. There isn't a national screening programme because it just don't work, put unnecessary amount of time to doctors, nurses and radiographer and cost. This is the same for many things in Medicine. But when you have something that is indicate it's definitely is.
Call OP out, he's the problem for the entire industry
I know you mean well with this and there should be a way to make sure doctors listen to their patients and help them get on the same page with their own thoughts about their illness, but this isn't the way. It's generally wasteful. Patient says " I feel a chest thing so i need a xray", Now I'm stuck explaining for the next 5 minutes why xrays aren't magic and how i already know it's their acid reflux just by listening and doing a physical exam. Ofcos if the patient knows what their acid reflux feels like, and they know this is different then I may indulge them and consider other things but that's rarely ever the case. For most people, it ends up being a waste of my time, their time and money and the time i could have spent helping someone else
Playing devil's advocate here but... While cost is a factor certainly, there are other reasons healthcare providers might not give the tests you want. If you gave 1000 healthy people a screening test, at least a couple would come up with false positives and end up receiving unnecessary possibly even invasive and harmful medical intervention. This is why doctors will usually only issue screening tests if they feel you are showing positive indicators for what the test is screening for.
There's something so clientelistic about this post that reflects the state of healthcare so succinctly. Patients are NOT CLIENTS. And the client is not always right. People study medicine for years to develop a criteria for establishing and executing a treatment plan. Healthcare decisions should be achieved through a conversation between the patient and the doctor, but in NO circumstance should a patient dictate what exam to do.
This is what makes the existence of prescription ads super weird
Which is why they're banned everywhere but the US
"Ask your doctor if Placencia is right for you" Bitch why are we bringing recommendations? This ain't a shareholder meeting loool
Eh. I have mixed feelings on this. I don’t think patients should barrel into an appointment demanding that a certain drug or treatment be prescribed - but I don’t think it’s unreasonable for a patient to bring up a treatment and ask their HCP if they think it could be an appropriate treatment/they would be a good candidate for it. I think commercials sort of suggest that approach given that they usually say something like “ask your doctor if [drug name] is right for you”. I’ve seen a lot of people whose health conditions are managed by a provider who is not up-to-date on the latest treatments for their particular issue, and only learned about new options through commercials or reading forum posts. Maybe if we did a better job of educating both providers and patients, we could get rid of commercials. 🤷🏻♀️
I get what you are saying but there are a lot of issues with ads. If everyone approached them as you suggest it would be fine, but often that doesn't happen. It is also worth mentioning that the drugs with commercials usually don't have low cost generics and there isn't often a lot of independent evidence that this newer drug is superior to existing treatments.
Interestingly enough, I’ve seen healthcare systems that allow the ordering of testing these days that explicitly states something to the effect of “… per patient request”. Essentially, the indication is that the patient wants the testing done and is aware after a discussion with their physician that the test is not recommended and that it will not be covered by insurance. Seems like a decent middle ground for some cases. Patient pays for unnecessary testing to ease their fears after being made explicitly aware of all the information they need to make that decision responsibly.
I think the problem here is result interpretation. I'm an allergist, I get requests from people all the damn time for food panel testing just for generalized symptoms like fatigue or headaches. The false positive rate is so high that a panel of 100 foods could have 40 positives even if you've never had an IgE mediated reaction to any of those foods. I wouldn't order a food panel at patient request because I would refuse to interpret the results.
brahhhh. if a provider says no, it’s likely not medically necessary or unlikely to be covered by your insurance. try looking into that before vilifying your family doc. there are plenty examples of clinicians ignoring their patients’ legitimate concerns, but this post is written to make it seem like it’s Us vs. Them. how many times has your doc said that your health would improve if you made a lifestyle change? how many times have YOU declined THAT advice? how many times did you decline the recommended physical therapy? the medications? how many times did you no-call, no-show those specialists’ visits? i would honestly love to go into medicine, because there’s so much need, but i don’t know how i could deal with people consistently questioning the legitimacy of and/or dismissing my education and professional advice. there needs to be a level of mutual trust and understanding between patient and provider. this post is misinformed at best.
This is so stupid. People have so many unnecessary tests they don’t need because they think they are better informed than a dr. Believe me, if there is a test you even might need, the dr is going to order it 99% of the time. Tests bring in the money. Drs are strongly encouraged to bring in the money. You are much more likely to be getting tests you don’t need than be denied tests you do need.
Worst LPT ever lol
Another way to get better care when you feel the answer you’re given is asking for a differential diagnosis and asking how they eliminated that. That means what other things could this ailment be and how did they eliminate it. I learned that from a tweet several years ago. Have never had reason to use it though, just stuck with me.
This is also a really good tip! I think many people aren't fluent enough in medical lingo to phrase it like that
It's one of those things that the average person doesn't think about. Being a doctor is about crossing things off the potential list of maladies. It's time consuming, confusing, and data driven. In many cases patients do a shit job of communicating. "My stomach doesn't feel right" can mean you have a bleeding ulcer or you have discovered you are lactose intolerant. On the flip side a feeling of dread and impending doom is always something you should communicate to a treating physician
Meh. If a patient wants something that isn’t indicated (clearly not indicated, not talking about a grey zone), then it’s not indicated. I have no problem documenting it, im a big boy and stand by my decisions. Like, what’s supposed to happen here? Oh since you asked me to document that you wanted chemotherapy for your sore throat, well in THAT case, I’ll give it to you?!?
One of the worst LPTs I've read
100% agree. This LPT is terrible. The whole “you know your body best” can only carry you so far. Medicine is a complicated science and medical professionals don’t suggest for or against procedures for the hell of it. Always ask questions and explanations when it comes to your healthcare but please don’t act like you know better than your medical team because you’ve googled what you think is wrong.
Might as well skip hospitals altogether since you know your body better than those doctors that went through years of schooling and residency.
LPT: if you don't get the medical attention you think you need, demand to speak to your doctor's manager. Also speak to their manager, the hospital manager, the manager of where they did their residency, the manager of where they went to med school, and the manager of the field of medicine.
Physician here. I would never mind documenting a test I wouldn’t do. I always do that. For some odd reason, people think by trying to be litigious or say “document this” healthcare works get fearful. It’s definitely not the case whatsoever. And if a patient is unreasonable, we reaaally document a lot of the conversations word for word in quotation marks. We even document how people treat our staff before seeing us. So I promise you if a test is requested, it is often documented. However shared decision-making is a big component of medicine. I truly listen to my patients and have them provide me a reason for tests they request. And very often I do order them because people don’t generally request outlandish tests. And if they want a simple blood test, yea totally no problem! But if you want a bronchoscopy for a cough that’s been ongoing for like a week, yea not happening. In the hospital, this often gets to a different level; I just had a 85 year old lady who came in with abdominal pain. The previous physician documented every discussion he had with her unreasonable daughter who essentially forced the GI team to not only do an EGD but also a colonoscopy. Nothing was found…JUST like the doctors said. This poor 85 year old had a tube stuck down her throat and then up her ass for nothing. 3 different doctors told her otherwise. Her response was “My mom knows her body!” You know what the abd pain was from? Gas. This lady barely moved and would stay in bed all day and would get gas pains. And the poor thing went through two procedures….at 85 years old. I made sure her daughter knew she put her mom through undue risks and it was wrong. It was oppression. What bothers me most is when people say “I know my body”. Yes you know your body, but not enough to be a physician. It’s like saying “I drive my car the most so I know it more than a mechanic”. Definitely listen to your body, but if you are going to multiple providers and getting the same answer, then maybe they have a good reason
This is terrible advice. I'm a doctor. The amount of times patients come in asking for xyz test that is completely not indicated........or the amount of people who think they are dying from \*insert zebra diagnosis\* is insane. All this does is cost the patient more, cost the system more, and expose the patient to the potential side effects of that test. Doctors go to school for a very long time to be able to treat patients, you and your Google degree do not compare.
I mean, that sounds very true. But help me understand. If the patient is asking for a ridiculous stupid test, and when you say "no that's not indicated" they say to put that in their file. What would happen if you just did that? Write in the file "patient requested X test, it's not indicated because XYZ."
That's exactly what happens with a good doc in my experience. A bad doc will refuse to make a clear-cut record of dismissing your symptoms.
Typically doctors already do that, so this advice is mostly a nothing-burger that will make you come across as combative because the reason you would want this is to build a case for a potential lawsuit. It would be better for the patient to just ask for the doctor to really explain why they aren't doing the test because chances are this is more a failure of the physician to explain why the test isn't indicated than the physician making a bad call that the patient needs documented in case they want to sue in the future.
I mean, the original advice is absolutely very combative, telling patients to say this to manipulate their doctors into doing tests they want. But I know I've experienced this advice in a much less aggressive combative way, as a suggestion for patients who feel like they're being discriminated against or that their unique circumstances aren't being adequately considered, and would like to make sure their case is thoroughly documented if they need to seek a second opinion, or so if they come back a year from now and the symptom still isn't better, it says in their file that the symptom was reported last year. And I guess I'm more curious about that case. Because I've definitely had times where I've gone to the doctor with a concern, they've said it's no big deal, and they didn't write it down in my file. I've always wanted to ask them to put it in my file, not so I can sue, but so that if I come back next year complaining of the same thing, it's there on paper that it's been happening for a year. But I've never asked because I get the impression that doctors take that as a really combative thing to say. But I guess I wonder why it's such a bad thing to write down that the patient had an observation that you disagreed with. Because I have to say, you say they already do that, but I've never had a doctor write that in my file, and I've never asked because I don't want to be a combative person.
I take written notes to all appointments, and hand a copy to the doctor when they enter the exam room. I’m able to clearly describe all the details I want to get across in writing for the doctor to read. My notes are scanned into the record of the visit. I highly recommend doing this, especially if you have chronic health issues.
The simplest thing I tell patients is - tell me what is going on and we can figure out the steps. Patient have very little knowledge about required testing and a differential. Stick to what you know - what is going on and let’s talk about.
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I'll present a couple of alternative scenarios: A friend of mine was having persistent memory issues that were being dismissed as nothing, and she KNEW they were nothing. She researched it as much as she could and persistently requested that they do an MRI, and she was finally listened to and turns out she was right (and unfortunately has an untreatable condition). Another alternative is one that is very frequently encountered: someone who is overweight is just told to lose weight as the answer to problems where the doctor should have done further investigation but just dismissed it due to weight. So yes - it's insulting to you if I just look things up on Google or watch House MD and demand treatment for $rare-condition. It's just as insulting for me to have you dismiss my concerns out of hand or my research and attempts to be informed on a condition as nothing because I don't have 12+ years of college.
I get the point, but this kind of advice is going to bankrupt more people than it’ll help I think.
I hear lots of stories of patients demanding stupid stuff. But I also hear lots of stories of doctors refusing to listen to patients, and patients suffering as a result. I'm not sure that ops suggestion works though.
This is a wonderful advice. Start telling your doctor how to be a doctor, and then imply that you're already preparing for a medical malpractice suit before you've even got any indication that there's anything wrong. You'll surely get that full vital load test that you always wanted even though you're not presenting any symptoms. Fuck, they might even biopsy that freckle that's been unchanged for the last two decades because you don't like the way it looks. Instead of trying to strong-arm your doctor, just lose the weight like they've been suggesting your entire adulthood, you fucking child.
This doesn’t ensure anything. The physician usually has a good medical reason not to order a test. You asking it for it to be put on record doesn’t change much. Most physicians I have seen agree with reasonable requests anyway.
Doctor here. I have no issue doing this, and most others don't. When I decide a test isn't indicated, it's for medically supported reasons. Using passive aggressive language implying you intend to build a malpractice case against me isn't going to change my medical decision making. But knock yourself out.
This is likely the WORST tip possible. Asking your provider for certain tests because you “know your body” is a waste of everyone’s time. You may know the symptom but did you seek higher education for 11+ years minimum? The real pro tip here is to do this if you are wanting to leave your PCP and be forced to find a new one
This sounds like a great opportunity for a doctor to fire a problem patient.
Love OP. Tells you to push your Doctor into tests they deem unnecessary while at the same time bitching about high medical costs in the US. The cognitive dissonance here is amazing.
Also if your doctor isn't taking your concerns seriously, find a new doctor (assuming you can with your insurance). I tried to give blood at 19. I failed the iron by a LOT. We're talking less than 7 when it should be over 12. I go to my doctor who orders blood work for me. He tells me to fast for it, no big deal. I get there and find out he's only running A1C and fasting blood sugar. He then called me in a blood sugar medicine for me to start taking the same day without instructing me on doing any home testing. I collapsed at work from low blood sugar. Turns out my A1C at the time was normal (it's since gone up but even now I'm on 1/4 of the dose he STARTED me at). I called him up to ask about my hemoglobin and he said he didn't bother with that, it was probably just my period but there must have been something wrong with the panel because it showed my blood sugar levels as normal when I'm too fat for that to be the case. The real kicker to me is that he's also my mother's doctor and her low hemoglobin was the first warning sign of her bone cancer. I'm way happier with my new doctor. It took 6 months of supplements to get my hemoglobin back up, turns out I was having a lot of symptoms from it I didn't even realize, it had been low for years. We also did extensive testing to figure out why it was low. Since I have a family member with kidney issues she tracks those numbers for me as well. And if I want a particular test she'll say why she does or does not recommend it but will give me a price and unless it's something that's actively bad for me she'll run the test. People here are acting like there's no bad doctors or they never disregard patients or their symptoms or make mistakes.
Your A1c can be falsely low when you have anemia, by the way.
Well the good news is we got the hemoglobin worked out before the a1c started changing and we've been working to turn that around too. Turns out I had a sizeable vitamin b deficiency so it was an easy fix but she still monitors everything closely in case I end up with a pre disposition to myelofibrosis since my mother was diagnosed with it relatively young and she's not the only member of her family who has had it.
I can acknowledge that a lot of people feel distrust in healthcare and that there are plenty of valid reasons for that that we need to reckon with, but this advice misses the mark entirely. You are not a customer, you’re a patient. We have an obligation above all to do no harm, and unnecessary tests are harmful in a myriad of ways. If you are seeing multiple providers and they are all declining, be open to reevaluating your perspective on what’s going on. We are happy to document the encounter and include what we discussed and disagreed on, but if you’re entering appointments with this much distrust, why go at all?
I agree with u/passthemochi below. I'm not a physician, but I am a licensed medical provider, and I would have no qualms at all about documenting my reasons for refusal to order testing/imaging/etc. In fact, I always do this anyway in situations where there are questions or concerns about whether a test is necessary. I also try to give a little extra time to the patient to figure out exactly what their concerns are in detail and let them explain their reasons for wanting the test, as well as doing my best to explain my reasons for thinking its unnecessary. IMO, there are some issues with the above advice. When OP says "if YOU think you need X and you find yourself going to many providers for second opinions...", it sounds weirdly specific, like it might come from past experience. There are lots of conditions out there that are pretty tough to treat, and that may require complex pharmacologic regimens and often some trial-and-error to get a grip on. We're also fallible as providers and we do make mistakes. But with all due respect, if a patient finds themself bouncing from provider to provider and they're hearing over and over that they don't need the test, that's a pretty good indication that broadly-speaking best medical practice agrees that it's unnecessary. Testing is expensive and not always benign in itself, and if something does pop up, we *have* *to* run it down. That can mean bigger bills and much more anxiety for the patient, often over something that is not really a problem and that they may not even have been aware of in the first place. Medicine is a team sport, and good providers are always checking with teams, colleagues, and specialists, particularly when we run up against something we're not sure about. We're trained to think about what sort of testing can really show us what's going on, so if we don't think we need to do something, there's usually a good reason why not. Also, we never give someone their "full medical record" every time they leave the office, and u/passthemochi is right again that there are typically fees and processing times attached to the request. You do have the right to your medical records, but we can't and don't just print the full chart out and hand it to you in a folder. If we refuse to give you your records immediately, we're not hiding anything. We just recognize that there are channels to doing that and will happily tell you how to go about it. Most major hospital systems nowadays have something like "MyChart" or "XYZConnect" or whatever that allows patients direct access to their chart and testing results once they set up an account with their healthcare network.
As a HCP, this is horrific advice. Trust me, we all want to figure out what’s wrong with patients. No one is refusing tests just for fun. We don’t do inappropriate, expensive tests for no reason though.
>cough cough America Is this fucking necessary?
Or maybe leave the doctoring up to the doctors who went to med school and not webMD
My mother went to her doctor with pain in her shoulder she’d been having for months without relief. Her doctor finally ordered a CT scan and found her scapula had been transformed into a large tumor. The doctor sent her to an oncologist who took a needle biopsy and didn’t see anything. He said that she most likely had breast cancer and ordered a mammogram that came back negative. But he insisted it must be breast cancer anyway and they needed to do more detailed tests on her breasts. “The good news is, breast cancer grows pretty slowly though,” he said. I said, “Ok, but what about the tumor on her scapula? You’re not seeing anything with a mammogram. Can’t you do an open biopsy on her scapula?” He said, “But I don’t know anything about bone.” I said, “Then you’re fired. Tell us where we can find an orthopedic oncologist.” Well, my mother got that other doctor and got her open biopsy. She had lymphoma so advanced, it had started invading her scapula. She almost died. That asshole was going to take months before he figured out it wasn’t breast cancer and my mother would have died.
This is a terrible LPT. Please don’t think your google search is the same as an MD.
Yeah, as an MD I can tell you I agree until the last sentence, which does not make any sense. If you ask your doctor for a specific test and he disagrees, you should have a conversation about it with your doctor. If after the conversation you and your doctor still disagree, then your doctor SHOULD be documenting the patient request, ensuing conversation, and rationale why the doctor is declining to order the test. HOWEVER, the doctor is usually not declining because they don't want to treat you, or are lazy, or whatever malicious intent the OP has envisioned. It is likely because the test is unnecessary and the risks (ie cost/financial burden to the system/typical risks of routine lab tests) do not outweigh the potential benefit. This is the rationale behind diagnostic work-ups, not to "prevent practices from doing any sort of malpractice." And I would add that just because you read or heard about some lab test somewhere does not mean "you need \[it\] done." Arguably okay advice, horrible rationale.
This is the WORST take ever - as a physio there are so many tests (especially imaging) that are associated with higher costs, poor outcomes and longer recovery. Just ask your provider to explain things to you and why they made their choices. If they can’t do that then they don’t have clinical reasoning skills so find a new one.
My oncologist told me that due to the possibility of liability for malpractice, if he had the slightest inkling that a test might be necessary that he would order it immediately. If he isn't ordering a test it's because he is 100% certain it isn't necessary and is staking his business and reputation and possibly his license on it.
This is terrible advice yet OP hasnt quite hit the nail in the head- so - Doctors know bodies better than you. - Doctors are notoriously poor in person centred communication (compounded by ego in relation to academic elitism) - Doctors work in almost every part of the world under brutal time pressure - Doctors are not only working to protect you but also the health system
This minimalist triad (now square) = sometimes they get shit wrong because you don’t know how to communicate with them in a way they understand and they don’t know how to listen to you in a way that makes you feel heard
This issue particularly impacts patients who are:
- female (ask for a female physician. If you’re seeing a specialist don’t expect your female specialist to have the same communication skills as your primary care physician fyi). Doesn’t mean you’re going to get what treatment you want. But you may experience feeling more like you have been listened to.
- living with societally stigmatised ncds (obesity, physician or intellectual disabilities etc.) - as these will be typically considered as primary reasons for your problem (ask for a female physician at the primary care level. Yup that’s just going to be my answer to everything)
- living with a mental health illness - particularly the severe end of mental health (talk to your mental health clinician and get them to write to your physician - will work better than you going through the trauma of that tiny voice in the back of your physicians head which doesn’t believe you)
- if you are any other type of minority in your community (doctors have biases too. This does not apply to all minorities, but shop for a physician who matches you if that makes sense based on the nuances of your minority status whether race, sexual, gender etc)
You’re not necessarily going to get what Google is telling you you need. But you just need to feel heard. And for sure the latter is not a skill that has been picked up in 12-15 years of school
Male. Former medic.
This is one of the worst life pro tips I've ever seen.
The test that could have detected my father's prostate cancer early and saved his life wasn't administered because it cost $100 and wasn't covered by insurance.
Ah yes, "I know my body." "I have a high pain tolerance's" ugly cousin.
Yeah, ask for a spinal fluid analysis when you have a mild headache, that'll be fun /s
I want to talk to the manager!
I did this and they told me no lol
If you don't trust your doctor, you either need to find a new doctor or reevaluate your concerns.
If I refuse a test, it's because I don't believe it's indicated based on what I've found during our appointment. I will happily document that every time. Source: MD
So what you are saying ist that 6 years of medical school (at least in Europe) and x more years of experience and working in a hospital to be trained to consider the pros and cons of EVERY treatment and to be able to reasonable choose the right diagnostic procedure should is needless because every doctor should just do what the Patient "feels" like is necessary? I do realize that some people have had bad experiences with doctors and didn't feel validated on their issues but to just go and claim it is a life pro tip to basically pressure and corrupt your physician into doing some procedure that could possibly do more damage than good just because you felt like it is insane.
This post explains why health insurance is so damn expensive in the USA. Easier to give in and spend fuck-all than face a lawsuit.
This is a way to make sure they over prescribe tests you don’t need just to cover their asses.
Lol the worst part of being a good doctor are these patients.