Refuse Unnecessary Tests

Today I went to the doctor. All I wanted was a prescription to continue to go to physical therapy for my pulled groin muscles. The assistant said that the doctor likes to give new patients a full physical, which includes blood tests, EKG, and a chest x-ray. I said I had a physical recently (true) and those tests sounded unnecessary. She seemed disappointed. Unless I have wheezing or chest pains, I don’t see the need for a chest x-ray. See, doctors are like Best Buy. If you go in informed knowing exactly what you need, you’re fine. Otherwise they’re like oh you need Monster Cables and an extended warranty for your heart.

(Photo: RedandJonny)

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  1. LegoMan322 says:

    Ben…that might be the best quote ever on Consumerist.

    • absentmindedjwc says:

      @LegoMan322: yeah but, I want to know where I can get an extended warranty for my heart… that sounds like a pretty good investment actually..

  2. rickinsthelens says:

    Can you get Geek Squad to install your pacemaker too?

  3. Benguin says:

    You mean I DIDN’T need to recharge my plasma?

    Damn vultures!

  4. b.k. says:

    I got stuck with a $900 “lab” bill once. Ever since then I’ve made sure to be up to date with my family history in case a new doctor gets the idea I need to be screened for every obscure disease in the book.

  5. wardawg says:

    I plan on binge drinking and stuffing my face while I’m on vacation next month, can I get an extended warranty on my heart and liver?

  6. CreativeLinks says:

    Yes, but did you buy the extended warranty?

  7. yesteraeon says:

    It’s entirely appropriate for a doctor to want to get an overall picture of a new patient, which would include a physical exam and probably some tests. If you really think you know more than the doctor, I probably can’t talk you out of that. However, if you recognize that the doctor does have expertise that you lack, then you should also realize that it’s not the doctor’s job to just sign off on whatever prescription you want. It’s his job to monitor your health and help you to stay healthy and detect any illness that you may get as early as possible. To do that he needs data that come from exams and tests.

    On the other hand, if you had just had some of the same tests the doctor wanted to order, I definitely think it would be appropriate to mention that to the doctor or his staff and suggest that they could get the results from your old doctor, rather than repeating the tests.

    Disclosure of bias: I’m a med student.

    • Corporate-Shill says:

      @yesteraeon:

      And you are correct.

    • feckingmorons says:

      @yesteraeon: Appropriate, it is incumbent on the physician to perform a complete Physical Examination and obtain a complete physical from a new patient.

      Had there been an existing physician-patient relationship the tests may have been over the top, but a new patient requesting an order for physical therapy for a condition the doctor has not previoulsy treated is wholly innappropriate.

      Had the patient brought the results from their previous physician a number of those tests may have been recent enough that they need not be reprated, however the physician would have been obligated to perform a limited examination.

      Medical care is not like doughnuts. You can’t simply go to any shop that is convenient. If you want to bet the most out of your physician visits you must maintain an open and honest physician – patient relationship.

      The physician who wrote the original order for PT will have been provided with progress reports from the Physical Therapist, and based upon those reports, information from the patient on how the PT is working, and perhaps a limited physical exam the original physician could have determined if more PT was indicated. The new doctor had no history, no reports from the Physical Therapist, and nothing to go on but a patient asking for an order for a treatment they alone feel is indicated.

      • Eyebrows McGee (now with double the baby!) says:

        @feckingmorons: “Appropriate, it is incumbent on the physician to perform a complete Physical Examination and obtain a complete physical from a new patient.”

        Ben is also young and (presumably) reasonably healthy; a lot of routine tests get added to routine physicals as you get older. My first appointment with a new doctor has typically included an extensive medical history and a discussion of health goals, not a battery of tests. (I have yet to have an EKG or chest X-ray as part of a physical!)

        I’m not particularly in the habit of second-guessing my doctors, with whom I have good relationships, but I’m a little curious as to whether this is standard practice in his state, for his insurer, or for the health care system his doctor is with. It does seem somewhat excessive.

    • Skaperen says:

      @yesteraeon: So this is why medical care costs have been spiraling up out of control. The more medical knowledge we have about all the possible things that can be wrong with people, the more tests that have to be done. And that’s before we even have doctors repeating tests just because people have to see a different doctor for some reason. Sure, electronic medical records could help this. But that’s just a small part of the overall problem. There needs to be a fixed cost for basic medical needs, and medical science needs to figure out how to provide that at that cost. If it can’t, then it’s time to nationalize health care. Maybe you can work your way into the medical economics field.

      • Shivved says:

        @Skaperen: I’m not sure how you jump from repeating tests to nationalized healthcare, but I’d like to try to respond.

        First, I agree to a certain extent that computerized records would help some of this problem, assuming it can be done without putting patient data into the wrong hands. However, it’s just as easy for Ben to get his medical records from his old doctor and bring them to his new doctor.

        Next, I don’t think I’ve ever seen expanded medical knowledge spun as a negative before. Yes, it does lead to more tests, which cost more money. It has also greatly increased life expectancy, which is a pretty reasonable trade in my book. Of course, medical tests are optional. If you don’t want them the government is not going to force them on you. That reduces your costs.

        As for fixing prices, check out how Venezuela is fairing while trying to fix food prices. Price controls simply don’t work. People turn to the black market, which in medicine would mean doctors of questionable skill treating patients they shouldn’t be treating.

        Getting to nationalized healthcare does, I guess, alleviate a lot of problems. When there is a waiting list a year long to get an MRI or CT scan you can count on some people to simply drop dead before consuming any of that expensive healthcare. Plus, it allows the government to decide healthcare choices, in an effort to not “waste” limited resources on a hopeless case. If you think that is a good thing, then Canada is due north. I’m sure they wouldn’t mind one more patient on the waiting list.

        • TaterTom says:

          @Shivved: I don’t exactly comprehend how you go from wherever your post started to black market. That being said, you have a good point in the bit about computerized records. I feel it should be taken farther, with info in the cloud, and a more gathered, collective consciousness, but whatever. We’re just not there yet.

          I do have to ask where you gather your information about the idea that gathered information results in longer life expectancy. Honestly, I have to agree that as we’ve gone along, life expectancy has increased along with our knowledge of health-related subjects, but correlation does not equal causation. I’ll take the other side of this one, for the fun of it. But it’s hard to figure out which side of the [supposed] argument you are one. I will, until corrected, assume you are shooting for nationalized healthcare.

          Just to keep it clear, I am [personally] on the side of ‘ to hell with privatized healthcare.’ That doesn’t mean I am siding with nationalized healthcare, but I don’t agree at all with the system in place, and choose to circumvent it as much as possible.

          Also, I must inquire how not participating in the tests the doctors are selling reduces the customers costs. Please explain that point further, along with your stance on drugs[aka medicine]=life expectancy.

          • Eyebrows McGee (now with double the baby!) says:

            @TaterTom: “life expectancy has increased along with our knowledge of health-related subjects, but correlation does not equal causation.”

            And in point of fact, a lot of our life-expectancy gains have come from public health initiatives — sewers, universal vaccination, nutritional programs, pre-natal and post-natal care information and initiatives, etc. The kinds of things our privatized medical system barely touches at all, and are entirely the result of public initiative and public money.

        • Eyebrows McGee (now with double the baby!) says:

          @Shivved: “Next, I don’t think I’ve ever seen expanded medical knowledge spun as a negative before. Yes, it does lead to more tests, which cost more money. It has also greatly increased life expectancy, which is a pretty reasonable trade in my book.”

          We’ve created more medicine than we can possibly pay for, and we’ve created a situation where many go without inexpensive basic care while resources are diverted to pay for extremely expensive “above and beyond” care for the wealthy few who can afford it. It’s a serious issue in American medical ethics and one that gets a great deal of attention.

          Because of our pay-driven system, we have also created a system where ability to pay is valued over doctors’ expertise (in telling a patient, “No, you don’t need that” and the patient simply goes shopping until he finds a doctor that WILL give him Expensive Unnecessary Treatment Du Jour), and our for-profit insurance system creates incentives to overtreat to CYA.

          It’s not inappropriate to point out that these forces have created a system that is NOT evidence based and does NOT produce the best patient outcomes, but rather is based primarily on profit. That’s inappropriate.

    • sleze69 says:

      @yesteraeon: I agree 100%. Now if I have to pay out of pocket, I might second guess the need if I felt fine.

      Now that I have decent health coverage, however, bring on the tests.

    • bohemian says:

      @yesteraeon: Your in for a harsh reality when you figure out that people are not going to let you do a chest xray, full blood work up and an MRI because they stubbed their toe. Insurance companies won’t be amused with it either.

      Patient does not automatically equal stupid.

      • yesteraeon says:

        @bohemian: @Skaperen: You’re right of course that costs are out of control. And one reason for that is physicians over-ordering tests (partially out of fear of missing something and getting sued). But, a chest x-ray and EKG are basic and quite inexpensive tests that a very useful in screening for a large number of potential problems. And screening is an investment, because if a disease process can be detected early it’s usually going to make the treatment simpler and less expensive in the long run.

      • yesteraeon says:

        @bohemian: Patient definitely does NOT equal stupid. But doctor (usually) doesn’t equal stupid either and I think the OP was implying that it does. If you go to a walk-in clinic or to a primary care doctor who you already have a relationship with for a simple complaint (stubbed toe) they shouldn’t start ordering a bunch of fancy tests. And I agree that if they do they’re wasting you or your insurance company’s money. The patient in the case at hand was starting up with a doctor she had not seen before. And she seems to have a condition that’s going to require ongoing follow-up (as she’s undergoing continuing PT). So I still believe that it’s inappropriate to fault the doctor for doing a physical exam and order some basic (read: not an MRI) tests.

  8. reidnez says:

    The medical definition of a healthy patient: someone who hasn’t been thoroughly worked-over.

    There was a good article in Slate a while back, but I can’t find the link. The problem with all this testing is that statistically, there are a *lot* of false positives. These lead to invasive and unnecessary procedures which have the potential to do harm when there was nothing wrong with you in the first place. As long as medicine remains a for-profit business, some patients will needlessly suffer.

    Moral of the story: if you feel sick, go to the doctor. You know your own body and it is full of intricate feedback systems which will let you know when something’s wrong, if you listen. Be wary of letting a doctor tell you that you’re sick.

  9. rubyfrog says:

    This post = fail. The EKG and the chest x-ray might have been excessive but first off, you are a new patient and there’s rarely any harm that comes from being thorough. Secondly, if the doctor doesn’t screen with “unnecessary tests” and you have a myocardial infarction next week, I’m sure you’ll be MORE than happy to call your lawyer about your physicians’ negligence. Funny how not doing “unnecessary tests” becomes negligence if something actually happens, right? Doing a physical on new patients is standard policy with many physicians and is considered good practice.

    Oh and FYI, there’s MANY more indications for a chest x-ray besides chest pain and wheezing. Just because you read WebMD doesn’t mean you went to medical school.

    • Corporate-Shill says:

      @rubyfrog:

      Just because you can read the words, doesn’t mean you can fully comprehend the combination of words.

    • Easton21 says:

      @rubyfrog: The harm in being “thorough” is getting slapped with an unnecessary $900 bill. If I just recently got an oil change and had my system scanned, I’m not going to get another one just because I switched mechanics.

      PS – While you may try to imply that you’re a doctor, any real doctor would know the difference between “there’s many more indications” and “there ARE many more indications”. Go back to 5th grade English.

      • Mari Walker says:

        @Easton21: When did anyone say something about “getting slapped with an unnecessary $900 bill”?

        A doctor and a grammar elitist are not the same thing.

  10. Parsnip says:

    Vets are the same way. Last weekend, we had to rush our puppy to the emergency vet because she fainted. Several hundred dollars and several tests later, we had a diagnosis of a severe congenital heart disease. We didn’t sleep or stop crying the rest of the weekend.

    We took her to her regular vet first thing Monday morning to see what, if anything could be done. Her vet listened to her heart and looked over everything and informed me that my dog had fainted because of her Acepromazine, a tranquilizer she was on to keep her quiet after her spay the previous week. She did not have the congenital heart disease, and was in fact, just fine, and that should have been obvious.

    So yeah. Doctors are not always looking out for your best interest.

    • b.k. says:

      @pezstar: Hey, like I don’t have enough anxiety over getting my dog spayed this week. Now I get to worry about fainting?

      • Trai_Dep says:

        @b.k.: When I go in to get spayed, you damned well better expect me to feint. Often. In between my crying jags.

    • sleze69 says:

      @pezstar: There is a small difference in level of expertise between 1 health professional that has to have a broad knowledge of many different species and another health professional that specializes in a specific system (heart, brain, skin, etc) in a single species.

      By comparing Vets to Doctors, you just insulted the entire HUMAN medical industry.

    • Eyebrows McGee (now with double the baby!) says:

      @pezstar: This is why I have my vet fax all test results relating to serious diagnoses to my aunt who’s a vet (several states away). And as it turns out, the good vets who diagnose right and give me treatment options and care for me and my pet well are always HAPPY to do this — they want me to be reassured, they want another set of eyes looking at the tests. And the vets who balk at it or resent it have typically sucked.

    • JaneBadall says:

      @pezstar: My cousin is a vet. She is constantly warning me about unnecessary testing. Many veterinary clinics, especially emergency clinics, have a quota for tests performed each month. Doctors who fail to meet these quotas are ineligible for raises and can get fired.

      I’ve used a variation of Eyebrow’s method – asking if they would be willing to speak with my cousin on the phone so that I can get a second opinion. Several times the vets have become very hostile. I don’t know if it’s the god-syndrome that many doctors have or if they don’t want to get caught. I do know that I am still looking for a trustworthy vet.

      • Eyebrows McGee (now with double the baby!) says:

        @JaneBadall: We were lucky in finding the right vet locally on our 2nd try. The first guy was a freaking nightmare. I know we pay a little more than the local bargain-basement vets, but not THAT much more, and the quality of care is certainly worth the small “premium.”

        (Especially when, as for our chronically ill cat, more expensive proper care the FIRST time saved money in the long run. It’s a little more irritating to hear about the price differential on routine exams, but again, worth it.)

      • cinnarose says:

        @JaneBadall: Well, that explains the $200 pancreas function test they wanted to perform on my cat when she almost died from low blood sugar. Her pancreas is fine, btw, at least within limits for a 17 year old cat. I’m glad my regular vet is not crazy like the emergency vet. I’m glad they are there, otherwise she would have died, but I’m also glad my regular vet was willing to take her after she stabilized.

  11. Shivved says:

    This is good advice if you don’t have insurance. If you do, I don’t see a reason to turn down minimally invasive tests that will help a new doctor understand the state of your health.

    • DrGirlfriend says:

      @Shivved: Having insurance doesn’t mean you won’t end up with a bill. The norm is for insurance to cover a percentage of the claim, not 100%.

    • johnva says:

      @Shivved: A chest X-ray is not “minimally invasive”, in my opinion. I would not have one of those unnecessarily.

      • b.k. says:

        @Shivved: I always have to pay for lab tests, and I have insurance. And I’ve had the same doctors for years. Sometimes they get wild theories and I don’t want to tell them “No, let’s not test for that,” because if there’s something really wrong with me, I want to know… but it does suck paying off lab bills for six months.

  12. Parsnip says:

    How about the fact that the cost of those unnecessary tests is a significant part of the reason health insurance is so expensive?

  13. Anonymous says:

    It’s so weird reading items like this, since I live in Canada. Our doctors are encouraged to avoid unnecessary tests, and generally don’t do them since they don’t get any extra money by having them run. Privatized health care always just seems odd and broken to me.

  14. Silica says:

    The purpose of seeing a doctor is to obtain what’s “best” for you, not what you “want.” I feel certain that you could probably find a physical therapist who will treat you without a doctor’s prescription, if the price is right. It’s probable that you wanted to use your health insurance benefits to obtain PT. In that case, it is entirely appropriate for the doctor to ask for a preliminary examination, if you are not a known patient. You haven’t revealed enough details to elucidate what the doctor would be justified in ordering in the way of exams and/or tests. But the best advice was given above, i.e. let the doctor know what tests or exams you have had recently.

  15. facted says:

    Without knowing anything about your past medical history it is impossible for anyone on aside from your doctor to comment on why he/she chose to order the tests. I do agree that some physician order tests that are may not be useful or may be repetitive, but you may well have indications for the tests that were ordered. And as others above me have stated, unless you went to medical school, trained in residency, and saw thousands and thousands of patients, you’re really not qualified to make medical decisions for yourself.

    Do you have the right to ask questions? Absolutely. But bare in mind that your doctor knows more than you do.

  16. Despiridius says:

    Coming from a doctor…
    You were right to refuse those tests. A chest X-ray is not indicated in any patient without symptoms. Some physicians get a “baseline” EKG in patients who are older and have some cardiovascular risk, but that doesn’t seem to be the case here. The only “routine blood work” indicated might be a cholesterol screening, based on your age.
    These type of physicals with tests that aren’t indicated are usually reserved for “executive health” which has been shown to have worse outcomes.
    The reason you shouldn’t just get a routine chest x-ray is that the odds of you having something serious are far exceeded by the odds of having something benign – which would require further investigation and expose you to more procedural side-effects.
    I tried to keep this brief, but pages could be written about just how inappropriate this type of testing is. Good work on the refusal and you wouldn’t be wrong to seek a new primary physician.

  17. AlteredBeast (blaming the OP one article at a time.) says:

    This reminds me, I need a physical…and a visit to the dentist.

    >_<

    Though I’ve never had a chest x-ray for a physical.

  18. oneandone says:

    I’ve had uneccessary medical tests at the request of my insurance company. They thought they were neccessary, my doctor and I thought they were not. But they wouldn’t approve an MRI (to check for a slipped disc) until I got an EMG to check for nerve damage. Based on my symptoms, older test results, and a very thorough history, she diagnosed exactly what happened, and the MRI confirmed it. EMG and a few other tests were entirely unnecessary, and I’m sure the doctor isn’t happy about insurance policies second-guessing (or restricting) her expert judgement.

    There’s definitely a lot of unnecessary testing going on.

  19. Corporate-Shill says:

    Kinda of weird in that I have to prompt my GP to order more frequent testing.

    Not wanting to waste $, but being aggressive with monitoring a medical condition can result in fewer long term problems.

  20. Prosumerist says:

    The problem with comparing doctors to Best Buy is I can probably research redundant gadgets on a site like Gizmodo whereas it would take me a few good years to gain enough knowledge to question a physician.

    On the other hand a better pre-screening process would likely yield efficient results. Simply asking “are you experiencing any discomforts lately?” would justify x-rays more than the standard procedure.

    • bohemian says:

      @Prosumerist: Ahem. If I hadn’t second guessed two doctors and pointed out something I read online as a possible long shot to a horrible medical problem that wasn’t resolving I would be dead right now.

      Luckily one of the doctors was secure enough in his skills to refer me to have it checked into, they had already run out of ideas. I was right. I had an endocrine problem that was so bad I probably would have died if it had gotten any worse.

      Don’t get me started on the doctor that missed joint damage in my back and refused me any pain meds.

      • Mari Walker says:

        @bohemian: Your experience invalidates Prosumerist’s point… how?

        There are also plenty of people who let their online reading scare them into thinking they have something that they don’t actually have.

  21. Anonymous says:

    I definitely agree with yesteraeon. Unless this doctor has prior knowledge of you or you brought your records how is he supposed to adequately refer and treat you? Additionally in this sue-happy nation we have docs honestly you have to cover their ass before doing anything unfortunately. Take your ECG (EKG): It may seem excessive, but it is a simple test that gives some baseline information regarding the health of your heart. If he had discovered signs that you have some kind of heart problem (many of which are totally asymptomatic) he might not approved you for physical therapy and exerting yourself could put you at risk. If you die or suffer morbidity from cardiac problem in PT the next week I guarantee 80% of the population would be suing that doc in a heartbeat.

    If a doctor is doing a test that could give him information that would cause him to alter the way he is treating you it’s not an unnecessary test. If that is not the case then it might be unnecessary. Ask why he is doing something and what that would tell him, but he is just doing these things to keep you healthy.

    My bias is that I am also a 3rd year medical student.

  22. Kimaroo - 100% Pure Natural Kitteh says:

    As someone that doesn’t have health insurance, I think it’s fine if they offer these tests.. but when you go out of your way to tell them that you’re paying cash, I think they should let you know and ask you before they do any “routine” test they can think of.

    I went to my ex-gynecologist for a regular yearly exam and she apparently did so many STD screenings that my total bill ended up being over 400 dollars.

    Meanwhile I go to my exams every year and am a happily married woman who doesn’t sleep around.. and neither does my husband.

    While I know there could be some remote risk that he could have done something without my knowledge.. that risk for me is so low that I’d much rather have the options before having to pay so much out of my pocket for these tests that I feel that I could have done without.

    Thankfully my new gyno agrees and my bill last year was more than half off that amount.

    • the_wiggle says:

      @Kimaroo: sounds like your exgyno was like my exgyno. ordered every test under the sun except the test I wanted & had the audacity to tell my I had no way to know if I was pregnant with out a test for that, too. this, after I told him happy, closed marriage to DH w/a 3yr old vasectomy!

      love to find a new gyno in the Valley who actually listens to patients before running up the bill. . . .

    • Eyebrows McGee (now with double the baby!) says:

      @Kimaroo: “I went to my ex-gynecologist for a regular yearly exam and she apparently did so many STD screenings that my total bill ended up being over 400 dollars.”

      I paid that just for my first round of blood tests after I got pregnant ($383, to be exact, just for the testing, not for the appointment or anything).

      I know it’s a pretty comprehensive panel — CBC, various STDs, rubella antibodies, etc. — but it was still a pretty staggering number for two tiny vials of blood.

      “Meanwhile I go to my exams every year and am a happily married woman who doesn’t sleep around.. and neither does my husband.”

      And not to pick on you, because I’ve also had gynos who didn’t listen to me, but — as House likes to say, Everybody lies. The doctor can’t guarantee you — or your husband — are telling the truth, and some states are passing legislation mandating various STD tests at various appointments/part of various treatments because the “social stigma” of the diseases prevents people from getting tested, so routine testing can help get around that attitude.

      I know in my state, for pregnant women, a full STD panel is standard care, and an HIV test is REQUIRED by law now. You used to be able to opt out, but the people who opted out were often the most at risk (and as you know, transmission to the infant can be prevented if infection is known and treated), and those who allowed the HIV test sometimes found their insurance rates jacked for “risky behavior.” So the state mandated it to solve both problems at once.

      • Kimaroo - 100% Pure Natural Kitteh says:

        @Eyebrows McGee: I could see being extra careful when there is a baby involved. And I could also understand if it was a legal requirement, but neither one of those fit my situation. I was just pretty annoyed by the whole situation because I had seen her the year before when I did have insurance and she ran the tests then as well. I guess I felt that not much had changed to warrent the tests.
        I guess I just would have appreciated her asking me before she ordered them or atleast warned me about how high my bill was going to be since it was all coming out of my pocket. They wanted the money as soon as I was leaving too, so I was lucky I had enough money to cover it.

    • Mari Walker says:

      @Kimaroo: Well, the STD tests are a good thing to know… unless, of course, you’re the one footing the bill!

  23. wildhare says:

    This is a far sight better than when you have an HMO and you practically have to hold the doc at gun point to get any good tests done. I was tested for thyroid perhaps one and a half years from the last time I visited a new doctor and she said since they looked normal then there was no reason to order another test, even though it was done by a different hospital and HMO entirely.

    I dropped her.

    I can see if you are a non-HMO or non-insurance carrying patient it would be more concerning and doctors would be more apt to upsell their services.

  24. Rosasharn says:

    @peztar

    I thought the reason America spends so much more on medical expenses is because we don’t have preventative medicine like physicals and EKGs.

  25. drdom says:

    Did you consider that the physician has potential liability if they don’t perform adequate screening of a new patient. Although you know what it is you want to be treated for, have you considered that perhaps there might be a reason that what you’re asking for might not be appropriate. The only way to know is to screen the patient, which requires a standard set of studies.

    Physicians who routinely dispense prescriptions for medications, or things like physical therapy, etc. without adequate screening do their patients a disservice. And as said above, if you think you know as much as your doctor does, go ahead, treat yourself. Just don’t blame anybody when things go wrong.

    And, if you have had these tests done within the recent past, most physicians will accept those results, if you let them know what you had done and how recently.

    Physicians don’t go through 8 or more years of schooling and hundreds of thousands in student loans just for the opportunity to order unneeded tests. Most physicians don’t get any revenue from these tests in any event. And insurance companies only pay a small fraction of the billed amount, as full payment.

    I’m not saying there aren’t bad physicians. But few, if any get rich by ordering a chest x-ray or a blood test.

  26. humphrmi says:

    As a star commenter, I should stick to “if you can’t say something nice, don’t say anything at all”.

    But seriously – two doctors? Full physical at one, but you want the other to renew a script that the first one wrote? No wonder doctors are so afraid of lawsuits.

    My cousin is a DEA agent who prosecutes doctors who renew scripts without adequate health evaluations.

    • Rectilinear Propagation says:

      My cousin is a DEA agent who prosecutes doctors who renew scripts without adequate health evaluations.

      @humphrmi: The script was for physical therapy. I don’t think the DEA is going after people who get prescribed exercise.

  27. Intangible_360 says:

    This is why socialized medicine is simply a better system. It has its huge problems of course but as soon as money comes into the equation like this there is a conflict of interest for the doctor. When you are talking about your health, you shouldn’t ahve to worry about nullshit like this.

  28. krunk4ever says:

    See, doctors are like Best Buy.

    I disagree based on the fact you group all doctors together. If you had said doctors “can be” like Best Buy, then yes. But the fact you’re saying all or even most doctors are greedy and always trying to sell you more things than you need is just plain out incorrect.

    I’ve known doctors in both categories and guess who I stick with?

  29. orlo says:

    Going to the doctor for a “prescription” for physical therapy is ridiculous to begin with. Tests are actually one thing that hospitals are good for since it’s impossible to maintain your own equipment. Unfortunately, hospitals are well aware of their exclusive possession of this equipment, and gouge patients accordingly.

    Conclusion: avoid doctors unless you plan on setting them up for a malpractice suit.

  30. Anonymous says:

    The truth of the matter is that doctors are required to establish care of a patient within their practice before giving any care (like treating you for an illness or giving you a referral), which requires that they give you a physical. Your right about the silly tests (unless you’re secretly over 45, in which case the blood test is recommended), but the physical is a legal and ethical must.

  31. nagumi says:

    Gee, this all sounds so… off. Here in Israel, those would all be free. For every citizen.

  32. ohnoes says:

    How much do you want to bet that your knowledge of the physiology and pathology of the human body is less extensive than that of your average physician?

    Comparing a physician to a commissioned salesman is pretty insulting, and for all the articles that bemoan the state of health care in the United States, perhaps the stripping away of respect and autonomy from physicians is one of them.

    This is not to excuse poor physicians by any means – they should be rooted out and disciplined, even having their licenses revoked if so merited.

    Since the reply button isn’t working for me:

    @ pezstar – did you tell your vet that your dog had recently had the operation, as well as any medication that it was currently taking? I’m just curious.

  33. Skaperen says:

    I wouldn’t mind reasonable tests that have to be repeated … as long as someone else is paying for it.

    I had to change dentist because I moved to a new city. I got all my X-rays from my previous dentist and brought them in to the new one. He insisted he could not use them and had to run his own repeated set, which I had to pay 50% for.

    So in theory, electronic medical records should help the repeat issue. But there’s definitely some kind of scam going on to do more tests than needed. Maybe that’s the doctor’s or hospital’s insurance demanding they get those tests done. Or maybe they are trying to generate revenue to help pay off expensive medical equipment (like MRI machines).

    Something needs to be changed, and I’m afraid the medical profession itself isn’t motivated to do it.

  34. corinthos says:

    Pftt I fell off a bike going down hill. All I wanted was it cleaned. I got two xrays, one of those shoot dye into my veins and put me in a machine test, blood, and they wanted me to pee in a cup. I couldn’t and they were threatening to give me a catheder. That’s where i drew the line and was like ummm no I’ll leave I just wanted you to clean this.

    • feckingmorons says:

      @corinthos: So you didn’t want to be evaluated for a blood vessel injury, that is your decision.

      If you did little damage to your knee why did you go to the ER to have it cleaned? Either you manage your own injuries, or you consult with a physician and make your decision based upon their advice.

      You never have to do anything your doctor suggests, and your doctor does not force you to get any tests or procedures you don’t want. They examine you, tell you what they need to make a decision and let you decide how to procede. I am certain if you had a venogram you were given a consent form to sign, before you signed it the physician (not a nurse, or technologist, but the physician himself) explained the procedure, the risks, and asked you if you had any questions. If you signed the consent you must have been satisfied with the need for the procedure.

      The person responsible for a patient’s healthcare is the patient. You must understand why the tests or procedures are needed, what may happen if you don’t have them, and the alternatives to having them. The physician cannot possibly know all the questions you may have so if you do have any unanswered question you are obligated to be an informed patient and ask.

      You make your healthcare choices, not the physician. You pay good money for your doctors knowledge and advice, get all the value for your money.

      Your doctor would much rather have a patient who can say “I take a statin because I have high cholesterol, and I am working on increasing my exercise and watching my diet too.” as opposed to some fat slob in front of the TV who when asked why they take a statin answers “My doctor told me to, but I think he is in cahoots with the drug company because it is expensive.”

  35. boricuachick says:

    Now that I have one of those high deductible health plans, I avoid all unnecessary tests like the plague. I only go to the doc if I am really really sick. When you are paying actual money out of your pocket, you suddenly realize your dollar isn’t going very far.

  36. brosner says:

    This is a complex issue. Whether or not a test is justified depends of many factors such as:
    1. Cost
    2. Undesirable test side effects e.g. exposure to radiation.
    3. Reliability (false positives and false negatives)
    4. Clinical benefits, i.e. if the test indicates a disease or condition does the diagnosis affect a remedy if any.
    The classic example is breast cancer screening. There is a long running debate about the benefits of mammograms with no definite answers as yet.

  37. mac-phisto says:

    @oh noes: i’m no doctor. i don’t even play one on tv. but i have had a few physicals & i can’t ever remember ekg’s, x-rays & blood tests being part of them. ok, maybe blood test if you mean urine sample, but if you mean stick-me-in-the-arm blood tests…i fail to see the need for all this.

    this article makes me think my dentist may be shafting me a bit now that i read this. it seems that guy needs an x-ray every time i’m there.

  38. Pylon83 says:

    The reason medical care is so expensive has more to do with liability than it does with actual unnecessary tests. The tests wouldn’t cost so much if Doctors didn’t have to pay insane malpractice premiums, and the devices to perform the tests wouldn’t cost so much if the companies that made them didn’t have to pay out the nose in insurance and in judgments from product liability suits. It’s a sad state of affairs when doctors feel compelled to do repetitive tests just to make sure they are covered in case you decide to sue them later. Nationalizing healthcare isn’t the solution, tort reform is.

  39. Ben Popken says:

    Bonus points: After I refused all the additional tests with his assistant, and after waiting for 2 hours past my appointment time, the doctor showed up and performed the most perfunctory of introductory examinations. Then he asked me to show him wear it hurts. I showed him my groin area. He placed his fingers on the surface of the skin for a few seconds, then asked me to follow him into his office. I got dressed and waited as he checked a voicemail message on his Blackberry. Then he told his assistant that I was “all done” that I “didn’t like them” shook my hand, and sent me on my way and she wrote me a prescription for therapy. She asked me how many times a week I wanted to go and how long I wanted to do it for. “6 months sound good?” she asked. Blah blah blah. I got my script and got out of there.

    • Rectilinear Propagation says:

      that I “didn’t like them”

      @Ben Popken: What?

      I got dressed and waited as he checked a voicemail message on his Blackberry.

      Aren’t they supposed to leave you in the examination room while they’re doing that?

  40. scoopjones says:

    This is especially true if you have an HMO, which typically pays a flat rate to its doctors. They will sometimes try to pile on extra tests to run up fees. HMO dentists are the worst for this type of treatment. I once had an HMO dentist who tried to write me a $2,000 bill for 8 alleged cavities after a routine checkup. I refused it and found a PPO dentist who found I had one small cavity. Total bill? About $175.

  41. Corporate_guy says:

    The doctor needs to know about your health in order to write a prescription. It’s your fault for not having the results of your last physical so he could evaluate you. You were basically asking him to make a medical decision based on nothing.

  42. bohemian says:

    I went in to get a spring hayfever script. Every spring something sets me off and what was OTC at the time didn’t cut it. I went to the only doctor in town listed on my insurance plan as handling allergies. The CNP did some basic exam and questions. The doc reviewed the notes and suggested I have them use their new CT scan on me. I said no. I just need an allergy script I have gone through this routine every year of my life since I was a teenager. He pressed saying I might have a sinus infection or something else wrong in my head making my nose run and eyes itch. I again tell him no, I have not had any other symptoms and I realize I am accepting the risk if I have something else. Then they try to convince me because my insurance will pay for it and they just got the machine installed that week. Then someone comes in and tells me it will cost me $200 instead of $900 because my insurance will cover part of it. All of this for a stinking zyrtec prescription. I was so glad when that finally went OTC.

  43. Cary says:

    Here’s the deal: you’re going to die.

    The more you spend on tests, the more accurate the time frame as to when.

    But you’re going to die.

  44. frodolives35 says:

    Pylon83 BS BS BS Tort reform is not the answer. The reality is most lawsuits are settled at not much more then actual damages. Just because a few big buck awards ( that are most likely reduced later) make the head lines does not make it so. Insurance is however a rip off for everyone( except for people in the insurance industry). We do not need tort reform we need no fault type of insurance that covers everything, that will remove the profit all the way around.

  45. Pylon83 says:

    frodolives35 (I’m not sure why I can’t reply to comments, and it doesn’t seem you could either), while you’re right that many cases simply settle (though I’d take issue with the “not much more than actual damages), it still costs these companies truckloads of money in legal fees. It’s not just the damages that they ultimately have to pay, but it’s the constant legal fees for dealing with all the suits. The lawyers that work on some of the large product liability suits can charge upwards of $800-1000 per hour. I also don’t share your view that profit should be removed all around. If you take away the profit, you take away most people desire to enter the field. If there is no profit in medicine, the smartest people will be more likely to choose another field (some will still pursue medicine for personal reasons, but some will be lost), and if there is no profit in insurance, companies will simply cease to provide it. Insurance, health or otherwise, is not and should not be a right. However, insurance would not be as necessary if the costs of medical care were not so astronomical. It should not cost thousands upon thousands of dollars just to visit the ER or take a ride in an ambulance. The first step to reducing those costs is to reduce the costs and liability associate with providing such care. Tort reform is a good step in that direction.

  46. synergy says:

    And that is sad.

    I don’t know about others, but I got a physical needed for something, I forget what, and I was told my insurance only covered one per year. So maybe getting pushed for another one would end up costing you even more than you might expect.

  47. Lee T Yang says:

    Maybe it’s because you are going to sue him for 10 million dollars if he misses an osteosarcoma which can be seen with a cheap x-ray and an alkaline phosphatase blood test. If you think you are the doctor, why are you going to one?

  48. yevarechecha says:

    The last time I went to the doctor they prescribed an antibiotic that I was allergic to (but did not remember because the first reaction happened when I was 3). When I showed up a week later covered in severe hives and complaining of fever, dizziness and palpitations, they went back through my chart. “Oh! You had a previous reaction to this when you were little. I’ll write the note bigger this time. Here is a $60 Rx to get rid of the hives.” Gee, thanks. Irony of ironies: they gave me that antibiotic to avoid another antibiotic that I was also allergic to.

    What good are medical records if the doctors themselves won’t look at them? I don’t understand how all that paper mess can possibly be efficient. If it had been computerized they could have easily done a quick keyword search and found the note from when I was 3. Now I get to worry that the next exposure to this drug will involve anaphylaxes.

    • Rectilinear Propagation says:

      What good are medical records if the doctors themselves won’t look at them?

      @yevarechecha: Going to the doctor is also like getting passed around to different departments when you call up a big company. You have to give the same information to at least three different people and you’ll still have to repeat it for the person that’s supposed to help you with your problem.

  49. humphrmi says:

    Citibank: Please write this nice story about us. The last journalist did all the research, and to sum it up: “we’re a healthy company except this one, tiny itty bitty teeny weeny part.” Trust us. Now please write a nice story about us, about how healthy we are except that one tiny part. C’mon, you don’t need to research any further… we already went though this with the last journalist (whom we fired.) Just take his data, which we will tell you, no need to check with him, just run with it. We will absolutely tell you the truth. No need to check things out for yourself. What? You want more interviews? More research? Unnecessary! Too costly! We’re trying to save money here!

  50. dbcooper09 says:

    I really don’t appreciate the last comment of the post stating that “See, doctors are like Best Buy. If you go in informed knowing exactly what you need, you’re fine. Otherwise they’re like oh you need Monster Cables and an extended warranty for your heart.”

    I don’t think its fair to paint all persons of a chosen profession with the same brush as one person. I’m a physician myself, and I order tests as I feel as necessary to diagnose a patients condition. I didn’t spend all those years of training just to fill out prescriptions that patients tell me they want.

    When a doctor writes a prescription they do so using the knowledge of a patients conditions and how they might react to the medication. It’s perfectly reasonable to order tests for a new patient. Its also perfectly reasonable to refuse tests you feel are not needed.

    It just really irritates me that the write of this article would make such a blatant statement. Basically stating that all physicians are just slick salesman who are trying to just make money off you.

    I’ve been reading the consumerist for quite some time and I’m shocked that this kind of article made it past the editors. This sounds like one person’s opinion based on one experience. Its a logical fault that to assume that if one doctor orders a test that is not needed, then all physicians must either be out for only money or incompetent.

  51. John Luekemeyer says:

    I don’t really understand what the point of this website is. It’s basically the same people bashing the same stuff over and over again. The true people who are being “ripped off” as consumers by “everyone” will never ever read this blog. This website is on the verge of a “hate” website and shows no discretion for what is posted. Bashing companies left and right.

    If you are a smart person, you can just say “no” to stuff you don’t think you need. You don’t need to whine about how the sales person said “You need tapes with your camcorder” when you know you can get the tapes for cheaper from somewhere else.

    This is just ridiculous.

  52. John Luekemeyer says:

    And to add to that, what if you had a heart condition and the doctor didn’t offer you those tests? You would probably cry negligence. Just like if the sales person didn’t offer you the accidental warranty on your thousand dollar DSLR and you drop it on the ground. Everything is a ripoff until it is conveniently not brought up and things go sour because you weren’t offered something you would refuse anyways.

    Don’t be that ignorant consumer who whines when they’re offered something but then complains if something happens and they weren’t offered it in the first place.

  53. Melissa Huber says:

    I think the wisest course of action here would not necessarily outright refuse tests but start asking questions – “Is this standard procedure for new patients?” or “What is the purpose for ordering these specific tests? Do you notice something that might be odd?” If your physician cannot come up with a viable answer, then by all means, refuse the tests. I also agree with the comments about informing the physician that if you have had those tests recently, to inform them. Considering today’s sue-happy way of thinking, too many physicians are becoming paranoid about missing something or getting something wrong, so they err on the side of caution sometimes by being thorough, if not too thorough. Best thing to do in these situations as a patient is to simply communicate.

    (basis of knowledge – nursing student)

  54. Ananelle says:

    My reply button isn’t working.
    The more medical knowledge we seek, the more we are policed by the government and the doctors themselves.
    I’ve been reading way too much Foucault.

    The fact is… we are meant to accept that more medical knowledge is for the “general good of the people.” However, people do not understand they have a right to refuse this collection of knowledge. However, because of the society we live in, doctors also feel they have a right to refuse treatment because of this.
    In short, it is 5 am. I am waxing philosophical. I am happy you stood up for what you feel are your rights as a patient. Case closed.

  55. MrFrankenstein says:

    US doctors seem to be utterly lazy, and reliant on totally invasive procedures, rather than using their knowledge, ears, and eyes to determine (at least initially) as to whether there’s a problem.

    In my brief experience of US doctors, they have the bedside manner of abortionists – there seems little grasp of anything that the patient is stating or presenting in terms of symptoms. Its all about tests, and volume of patients seen.

    I consider a doctor who wants to do blood tests on a new patient, for no tangible reason, to be lazy, and barely above the level of a quack. If the patient is displaying symptoms of a disease, or high blood pressure, THEN blood tests may be indicated. Otherwise, a doctor wanting a battery of tests on a new patient, is displaying laziness and stupidity.

    Sticking needles into a new patient for nothing more than a medical exploratory fishing expedition, is blatantly ignorant.

    US doctors seem absurdly untrained in diagnosis. I’ve had nothing but good results from seeing non US doctors, on the few times I’ve needed to go to one. Whereas the US doctors treat patients like cattle – no attempt made to LISTEN to the patient, and make an expert assessment of their possible symptoms.

    I dont think the ordering of tests is about profit – its about badly trained doctors, who lack the skill to determine accurately when tests are potentially indicated – like using a shotgun on fish in a barrel, they’re hiding their lack of expertise behind batteries of tests.

  56. tinyhands says:

    In general, fail. Your body is not a big screen TV.

  57. mythago says:

    I would report this doctor to the state medical licensing board. It is completely inappropriate to do a “routine chest X-ray” on a patient who has no indicators of chest disease, and without bothering to obtain existing medical records. EKG’s not much better.

    I’d also bet my left tit that your doctor owns, or has a financial stake, in whatever lab was going to perform these tests.

    Oh, and get another doctor.

  58. mythago says:

    Wow, comments are screwed up.

    @drdom: Certain doctors need to stop using “noooooo lawsuits!” as an excuse to jack over their patients. Reasonable, medically appropriate examinations are necessary. A full battery of expensive tests is not – especially when those tests involve radiation. Oh, and what a coincidence that many doctors own, or benefit financially from, those labs performing all these ‘necessary’ tests.

  59. leetyang says:

    This “long shot medical problem” is the thing that people complain about in tv shows like Mystery Diagnosis and websites like Wrong Diagnosis. Those long shot diagnoses tend to be fatal, and worth millions in lawsuits. This article is the blind leading the blind. I hope the Consumerist doesn’t continue this trend of giving out medical advice.

  60. Anonymous says:

    As a primary care internist, I’m equally annoyed by you and by your physician. In most practices, new patient visits are scheduled with more time so that doctor and patient can get to know one another (they’re also reimbursed at a slightly higher rate, which allows for the additional time). If a new patient came to me and only wanted to spend 5 minutes getting a PT prescription without letting me discuss his overall health and his past medical history, I’d be really ticked. New visits are also the time when I talk most about preventive health and routine screening tests.

    On the other hand, a routine chest x-ray for an asymptomatic patient is a ridiculous waste of medical resources. Usually an EKG is as well, although if the majority of this doc’s new patients are Medicare it is somewhat understandable as the “welcome to Medicare” general physical is only reimbursible if you do an EKG, for whatever stupid reason. Depending on how old you are, labs may or may not be relevant. I usually get some baseline bloodwork on patients over 40.

    But I notice that you don’t say what your doctor actually asked for, just what the medical assistant said he “usually does” for new patients. MAs have pretty minimal training–what did the doc actually tell you?

  61. Despiridius says:

    Much discussion has been made about “screening” tests. The original post notes the patient had a groin injury, thus a chest x-ray qualifies as screening because there is no other reason to get the test. So what is the goal of the study? To find something “bad” that you can treat.

    Pay attention for a key point of population based medicine:
    There is no evidence that a screening chest x-ray prevents illness or lengthens life. Even in a high risk cancer population such as smokers, it has no benefit. You don’t have to take my word for it, it has been well studied. Here is but one meta-analysis citation:
    [www.ncbi.nlm.nih.gov]
    There are many more but I don’t want to bore you.
    So what is the problem with just doing a chest x-ray on everyone? If we did a chest x-ray on 1000 healthy 30 year olds, we would be unlikely to find even one cancer. We would however find many granulomas (benign growths, like a mole in your lungs) that would lead to follow up CT scans ($1000 each), and some of those people would get lung biopsies (>$2000), and some of those people would end up spending days in the hospital (>$5000) and one or two might even die from a complication. So you would be better off not doing any chest X-rays unless the patient has a symptom that gives you a reason to look. Symptomatic patients have a higher incidence of disease, making true positives rise in relation to false positives and making the test worthwhile.

  62. bobcatred says:

    I don’t think a physical is particularly unreasonable for a new doctor. If I were a doctor, I’d want to know exactly what I’m dealing with before dispensing medical advice or prescriptions.
    An EKG and chest x-ray aren’t generally part of a basic physical though, and that’s probably on the excessive side unless you have known heart problems or something similar. And seeing as this guy’s talking about a groin muscle, which is nowhere near his chest, I can’t say I’d blame him for nixing those test.
    If you did have a physical recently though, why can’t you just have those records sent over and save everyone some money and hassle?

  63. Mecharine says:

    Unnecessary tests are only unnecessary unless they find something your other doctors missed.

    Thats what happened to me, most of my previous doctors didnt recognize something was wrong with me until I went to a new doctor who did a chest x-ray on me. Suffice to say, that unnecessary test saved my life.

  64. Mesrop Abrahamian says:

    I wish my family doctor had been in the practice of giving me a yearly check up and a blood test. Maybe he could have caught my kidney failure (which was probably going on for years). You are probably right tho you don’t need excessive tests every single time you go to a doctor but a yearly or bi-yearly full body check up isn’t a bad thing.

  65. mrbuckles says:

    An electrocardiogram or “EKG” is a very simple, quick and inexpensive test for evaluating your heart. The cost is typically only dollars. The test is mostly performed in the MDs office and takes only minutes. The test is an important indicator of baseline cardiovascular function. It can also show chronic or congenital changes in the structure or conduction system of your heart. It is particularly necessary because if you visit your doctor in the future complaining of chest pain, pressure, palpitations or other symptoms he will be able to compare the old EKG with the new one. This is of utmost importance because the treatment of some cardiac arrhythmias are time sensitive. Furthermore, cost can be avoided in the future if your MD knows your baseline EKG and atypical EKG changes in the future, when you have symptoms, are not mistaken for more serious changes; because they can be compared to your old EKG. Also the detection of a number of possible EKG abnormalities may save your life or provide diagnosis before you even have symptoms. I actually tell many people to carry a wallet copy of an old EKG with them should they ever need a EKG by Paramedics. I would definitively recommend you have one performed.

    I guess I could write pages on how important this test may be. But, the fact remains if you did not get a positive first impression or do not have a sense of trust with this MD, I would not recommend going back. Find a MD who you are comfortable with, one who you trust and are not so quick to second guess.

  66. Anonymous says:

    My new ob/gyn did a pelvic exam without a pap smear. I didn’t think that took long enough at the time, I was right. She didn’t even bother. I did get charged $112 for her to take a look but not rub me with a swab. Grrrr! It had been 3 years since my last test, that’s the maximum recommended time. I called and talked to the office manager but she didn’t seem to care. I told her I would pay for the supplies and lab test, but that was it. She said to make an appointment. I doubt she will even mention this to the doctor and I get to make my point to another person. Lovely…I’m choosing a new doctor next year.

  67. Ben Morrell says:

    Some tests might seem unnecessary but my life was saved by an unnecessary test. So, while it might cost a little more, what is the value of them discovering something that could have killed you if it hadn’t been found?

  68. Rectilinear Propagation says:

    Meanwhile, I can’t get a doctor to test to make sure my insulin levels are normal even though I’m on medication to control it.

  69. gggtur says:

    You can refuse. However, my wife refused when she went to a new doctor. Turns out she has a tumor that could have been found with those tests. If you haven’t had them in a while and you have insurance, it is wise to do tests for physical check ups.

  70. vladthepaler says:

    i’m not a doctor. My doctor is a doctor. I figure he’s in a better position than I am to decide which tests are necessary. Seriously, if you can’t trust your doctor with your money, why are you trusting him with your life?

  71. Lynne Black says:

    That’s hilarious..but I bet you didn’t know this has ‘upselling’ has infltrated the world of veterinary medicine. My 8 year old dog had to have some teeth pulled, after the procedure I started getting postcards that my dog was past due for her ‘senior health check’ I phoned the office and asked why I was getting those since I recall having paid for an exam and blood work before the dental procedures. The response “a senior dog needs a full work-up, including x-rays and an EKG” I asked how much $$, they said only $500. I hung up…

  72. ohgoodness says:

    @ Eyebrows McGee
    I know! How dare those rich people try to get the most advanced health care!!!