Take a look at three experiences that readers have shared with me during the past few days.
“Connie” has been visiting doctors because of a problem that might involve one or more organ systems–or might be nothing significant. Apparently, the radiologist now wants to run a third test. Connie wonders whether such extensive testing is worth the risks of possibly excessive exposure to radiation.
Radiology is indeed an area of overuse. Yale University radiologist Howard Forman told an Institute of Medicine workshop last year that the demand for “one more test”–often supported by the argument, “Don’t you want to rule out a really serious disease?”–leaves patients unprepared to resist unnecessary imaging tests.
Researchers have found that (except for mammography) “habit, anecdotes, and biases”–including a desire to avoid malpractice liability for undetected cancers–play the greatest role in physicians’ recommendations for imaging tests. Benefit-cost analysis and benefit-risk analysis play only a small role.
Connie might be wise to consult with her primary care physician (see our Aug. 3 post on primary care, below). She’s entitled to a plan of care that lays out exactly what measures will be taken, depending on potential clinical and test findings. Otherwise, she may continue to lurch from test to test, with no resolution in sight.
Connie will have the best chance of persuading her primary care doc to help develop a care plan if she plans her visit (as discussed in our book in section 1 on “Presenting a Problem to a Physician,” available on this site at no charge). She also could bring an advocate with her (section 7 is on “Bringing a Friend with You to the Doctor”).
Another reader concern: “Ted” has a very elderly mother in hospice, with problems that include advanced dementia. (See our July 29 post on conversations about end-of-life care, below.) Now she may have broken her hip. There’s an order not to take her away from hospice to the hospital, but the family is concerned that a physician might transfer her in order to treat the hip.
This is probably a less serious concern. If the hospice is alert to the possibility, it will prevent an inappropriate transfer. So the family’s job is to make sure the hospice is on guard.
Our final reader concern: “Jackie” was awakened during the night with a racing heartbeat, diagnosed in the emergency department as atrial fibrillation. After several months of doctor visits and tests, Jackie was found to have premature ventricular contractions. She was confused and worried and told one doctor, “I just want my life back.”
Eventually Jackie was referred to an electrophysiologist, who, she says, “is the best communicator I have ever encountered in a doctor.” He carefully explained each of four treatment options, along with their risks and benefits. To supplement this oral information, he gave her his own 4-page guide to the same topic.
When it came time to see the electrophysiologist again, Jackie brought a friend. The doctor appeared to appreciate the friend’s presence. Together, they decided on a course of action. During one procedure, the doctor even called Jackie’s family to report on its progress. Afterward, as she prepared for a trip abroad, he gave her explicit instructions about what to do if a problem occurred.
She says: “I am so thankful I found this doctor. . . . We work as partners in my health care. I have learned a lot about doctor communication and dealing with hospitals. . . . I learned that you have to have an advocate go with you. You seem more important to the health care providers if someone else values you enough to be there (especially at the hospital).”
Way to go, Jackie!! Take care.