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.
That advice was born from women minorities struggling to get doctors to take their concerns seriously. Look, I get that medicine is a risk/benefit analysis, but patients also need some level of recourse if they aren’t being listened to. I can’t imagine what it would feel like to be pushing for tests because you know something is off, only to finally be tested and told it’s too late, maybe if it was caught sooner. Yet, we know this happens. We also know that women and minorities receive demonstrably different care. That fact alone shows there are plenty of situations where a patient may need to fiercely advocate for themselves and question their doctors’ judgment.
I’m not saying completely ignore medical professionals and scream “lawsuit” because google. However, you live in your body and understand your own baseline more than anybody. Sometimes you absolutely can tell if something is truly wrong. Personally, I learned the difference between bad pain and there-is-something-fucking-wrong-you need-to-go-to-the-ER pain in my early 20s when I had ovarian torsion. Thankfully, I was at one of the best hospitals in the country, got a CT scan, and was in surgery lickety split. However, I met someone who had pretty much the exact same symptoms and story and ended up losing an ovary because she was sent home from the ER with them telling her it was normal cramps & anxiety.
Ultimately, imo it should be about informed consent. If you’ve gotten the same answer from 5 doctors and you still want the biopsy, despite the risks that have been plainly laid out for your, then fine. If you end up paralyzed, then you have to deal with the consequences of your decision.
I’m well aware of those biases, and I practice with the thought of always assume the patient is right and telling the truth. However once all the initial testing, exam, records scream negative, now you have someone that the best course of action is to help them understand they are not sick and truly healthy to avoid unecessary tests and complication. Surprisingly, some don’t like to hear that they are fine and healthy. Some Psych patients have much higher mortality, not because of being ignored, but because of over testing and complications.
Bad news, the biopsy had complications and now you’re wheelchair bound for the rest of your life.
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.
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.
FYI, finding an incidentaloma and doing another scan 3 months later to see that it’s disappeared is also life saving. My mother had a lung problem, got some imaging done, they found a lump in her lung, and instead of going directly to poking it for a biopsy or surgery, they checked 4 months later, and saw that it resolved on it’s own. If it was cancer, they would have seen changes in it, and known it was something to be investigated further at the time of the second scan. Doctors need to manage expectations and refer people for therapy if they have anxiety around their health.
Oh for sure, my comment is more towards people that won’t accept the diagnosis of everything is fine and no further testing is needed. Those people tend to yell, sue, go find some other doc, try chi blocking and crystals before they will talk to a therapist about their anxiety.
My comment about incidentaloma is more when you find something that wasn’t causing any true issue. Now what. You have to get another scan. But before that, there was no indication that anything was wrong because nothing was wrong. Now you’re stuck working and monitoring something that ends up being benign and would have been that way if you never look.
Same with any tests, there’s a rate of false positive to be aware of. When your suspicion is high, it outweighs it, but when it’s low and the test comes back positive, your stuck now and are often obligated to do unecessary work to prove that it was a false positive.
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.
That advice was born from women minorities struggling to get doctors to take their concerns seriously. Look, I get that medicine is a risk/benefit analysis, but patients also need some level of recourse if they aren’t being listened to. I can’t imagine what it would feel like to be pushing for tests because you know something is off, only to finally be tested and told it’s too late, maybe if it was caught sooner. Yet, we know this happens. We also know that women and minorities receive demonstrably different care. That fact alone shows there are plenty of situations where a patient may need to fiercely advocate for themselves and question their doctors’ judgment.
I’m not saying completely ignore medical professionals and scream “lawsuit” because google. However, you live in your body and understand your own baseline more than anybody. Sometimes you absolutely can tell if something is truly wrong. Personally, I learned the difference between bad pain and there-is-something-fucking-wrong-you need-to-go-to-the-ER pain in my early 20s when I had ovarian torsion. Thankfully, I was at one of the best hospitals in the country, got a CT scan, and was in surgery lickety split. However, I met someone who had pretty much the exact same symptoms and story and ended up losing an ovary because she was sent home from the ER with them telling her it was normal cramps & anxiety.
Ultimately, imo it should be about informed consent. If you’ve gotten the same answer from 5 doctors and you still want the biopsy, despite the risks that have been plainly laid out for your, then fine. If you end up paralyzed, then you have to deal with the consequences of your decision.
I’m well aware of those biases, and I practice with the thought of always assume the patient is right and telling the truth. However once all the initial testing, exam, records scream negative, now you have someone that the best course of action is to help them understand they are not sick and truly healthy to avoid unecessary tests and complication. Surprisingly, some don’t like to hear that they are fine and healthy. Some Psych patients have much higher mortality, not because of being ignored, but because of over testing and complications.
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.
FYI, finding an incidentaloma and doing another scan 3 months later to see that it’s disappeared is also life saving. My mother had a lung problem, got some imaging done, they found a lump in her lung, and instead of going directly to poking it for a biopsy or surgery, they checked 4 months later, and saw that it resolved on it’s own. If it was cancer, they would have seen changes in it, and known it was something to be investigated further at the time of the second scan. Doctors need to manage expectations and refer people for therapy if they have anxiety around their health.
Oh for sure, my comment is more towards people that won’t accept the diagnosis of everything is fine and no further testing is needed. Those people tend to yell, sue, go find some other doc, try chi blocking and crystals before they will talk to a therapist about their anxiety.
My comment about incidentaloma is more when you find something that wasn’t causing any true issue. Now what. You have to get another scan. But before that, there was no indication that anything was wrong because nothing was wrong. Now you’re stuck working and monitoring something that ends up being benign and would have been that way if you never look.
Same with any tests, there’s a rate of false positive to be aware of. When your suspicion is high, it outweighs it, but when it’s low and the test comes back positive, your stuck now and are often obligated to do unecessary work to prove that it was a false positive.