this post was submitted on 31 Jul 2023
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I've never tried this, but advice I've seen online is if your doctor won't order testing, ask them to note in your chart that they are declining testing. Apparently the implicit threat of a lawsuit if they're wrong is enough to kick at least some of them into CYA mode.
That's terrible advice. I don't know if any doctor that is "out to get you" by not ordering tests. Tests are not harmless. Improper testing can kill you. For example, you have a headache with no red flag symptoms. You keep pushing, some doctor orders an MRI and now you have what we call an incidentaloma. Some incidental mass that isn't going to cause you any issue and is unrelated to your headache. Now you latch on to this abnormal thing, you worry about it, it affects your life. More scans and tests are done to figure out what this is. Eventually a biopsy is offered. Good news, it's just some normal cells that happen to look funny on MRI, but completely benign. Bad news, the biopsy had complications and now you're wheelchair bound for the rest of your life.
It's thoughts like this where the "advocate for yourself" has turned into the "threaten the person that dedicated multiple decades of their life to help others to get what you want" that has lead to the insanely piss poor defensive medicine in the United States.
Tldr: refer every patient and order every tests until someone dies of bankruptcy or an unecessary complication because webmd.
how often does this actually occur? I assume if they're doing biopsies of brain material there's a risk but seems like it's a low probability if they're biopsi-ing your liver...
Also, when physicians find something wacky or unusual, is there any desire to do more imagine to see if that's the only oddness? for example, I had a retrocecal appendix (discovered during my appendectomy) - is that the only thing going on that's funky / unusual, or should I check / have imagine for other stuff? My docs didn't have a consistent answer - one said yeah, one said nah, one said it's nbd but if it was their appendix they might ask for other tests. :|
Fortunately my insurance is about as likely to pay for extra stuff as it is to cut my copay to zero, so it's not an issue I can address, but it does hang around in the back of my head.
Thanks for your insights!
Not frequent, but enough to make you question are we truly doing no harm when we indulge people. Medicine is an art, at the end of the day its a mix of statistics and experience. Not everything has a clear cut or even a right or wrong answer. Do this long enough, and you'll see things that have minimal risk turn into a clusterfuck.
For your question, yes I've seen minor things end up killing someone through sheer bad luck things can spiral out of control despite all the right steps being taken. Hence the inherent risk they mention of death during all informed consents.