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

Can you get Geek Squad to install your pacemaker too?

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

Damn vultures!

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.

@rickinsthelens: Besy Buy is not responsible for any lost data or angina.

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?

Yes, but did you buy the extended warranty?

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.

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.

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.

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.

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.

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

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.

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.

@yesteraeon:

And you are correct.

@rubyfrog:

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

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.

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.

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.

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.

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.

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.

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.

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.

@Despiridius: That's good info to know about the dangers of unnecessary testing in regards to finding benign things. To clarify your post, didn't you mean the odds are much greater to find something benign as oppossed to serious?

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.

@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.

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.

@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.

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.

@Despiridius: Chest x-rays are not indicated in asymptomatic patients. Are you out of your mind?

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.

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?

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.

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.

@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: 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%.

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

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

@feckingmorons: Uh, s/he didn't say otherwise...

@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. . . .

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.

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.

@Intangible_360: I'd rather use the term "nationalization of healthcare".

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.

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

@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.

@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.