… and how clinicians should respond to such.
Interesting.
Doctors can be awful communicators. I feel that for some, it is easier to write a script or order a test (even if a patient is not asking for one) than to get down to the source of their patient’s concerns. Which may send the doctor down a rabbit hole not necessarily leading to good treatment decisions.
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I feel like I just experienced this article. I am diabetic and have shown no control through diet/exercise, metformin or Ozempic. At my last appointment, I thought a referral to endocrinology may be appropriate. Instead he referred me to bariatric surgery. I don’t meet their criteria as my BMI isn’t high enough. So now I’m just waiting for my next appointment. It’s not just patients asking for tests - it’s referrals to areas hospitals can make $$. I used to love my doctor but now I would switch - if I could.
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What prevents switching?
Availability. I’ve seen him for over 15 years and there is no guarantee anyone else would be any better.
Well…the current doc isn’t helping you. The next doc might send you to the endocrinologist without waiting 15 years to do it.
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From the article:
Such requests are common, arising in up to 15% of outpatient visits,1 and have likely been fueled by direct-to-consumer marketing of pharmaceuticals and other medical services.
Hopefully TV ads targeting consumers will again be banned as they were before 1997. Only the US and New Zealand allow them presently.
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I’m not fond of the tone of this article. Maybe instead of giving ways to deny, the medical profession should consider that a patient with a lifelong or chronic issue may actually have studied it in-depth, be very familiar with their own body and response, and be asking for appropriate actions.
In our area, we see doctors much more likely to push off to specialists, rather than deny the use of one. We miss the days of general doctors. It’s very time-consuming and expensive and requires lots of travel when it seems they want one to have a specialist for each body organ.
I had a dr. refuse a Vitamin D test because “everyone in our state is Vitamin D deficient.” OK…so maybe we should treat that if one is symptomatic?
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Not trying to be pedantic, but this is not really an article. It is a research paper with citations and data. It was written with the medical community in mind. The goal is to help clinicians mitigate increasing patient requests for their own treatments and diagnostics, and to help them manage these increasing requests. I think this statement is key: “visits in which physicians explored and validated patients’ concerns were associated with higher diagnostic accuracy and better prescribing quality without increasing visit length,5 suggesting that exploration can improve care without compromising efficiency.”
I am sure you know your own body best. I don’t think you are the target audience for this paper.
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I take medication, some for problems but others as precaution. I also had cancer last year with 3 surgeries and radiation. I started having dizzy spells, and asked if it could be any of the medications. Oh, I needed tests for heart issues (none showed), for this and that. No reason for the dizziness. I also did my own research and some showed dizziness as a possible symptom. But my doctor doesn’t believe those warnings.
I’ve cut down on my medications and feel better. I may be dying because of not taking the medications but at least I’m not dizzy. I’m also refusing more medications until I know if these are working.
Also ready for a new doc, and I’m looking but it takes a while to set that up, especially since I don’t need an apt right now.
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I actually read this as a study suggesting more active listening and kindness in responses by doctors.
It was interesting from my point of view because I actively avoid unnecessary referrals, testing and medications and choose doctors who don’t send me down rabbit holes. For me avoiding medical harm is a priority and my “slow medicine” providers are on board with that for me.
My last specialist, who knows I read about my disease, asked me “So, what do you want to do?” Next best thing to a prescribing pad!
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I have a real problem with doctors assuming they know better, and/or talking down to patients. I remember who the premeds were in college, and they were nothing special, though doctors love to crow about being the “best and brightest”.
I’m fresh off some anger because the doctor (actually a PA) denied my son a flu test despite symptoms and an exposure, on the grounds that it wouldn’t matter. Well, it would matter, both for potential anti-virals on time and because of exposure to friends on aspirin therapy (risk to her of Reyes). I actually did a formal report of the practice to “patient relations” but am not holding my breath to hear back.
I finally got sick of doctors introducing themselves to me as “Hello Firstname, I’m Dr. Lastname” and I entered “Dr. FretfulLastName” under the “What do you want to be called?” which I assume is meant for nicknames. Well, too bad; they can use my title if they use their own.
I understand that the article may advocate active listening, but it got my dander up that the implication is that a 19yo would need a PCP’s permission to see a dermatologist about acne, or the other examples highlighted. We have way too much gatekeeping in our system, often by people who are not doctors at all.
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To clarify, I haven’t been diabetic for 15 years. I can assure you I’d have a new doctor were that the case.
I think physicians associated with a hospital system are under enormous pressure to see a high number of patients and may not have the luxury of time to listen. I know what I’m scheduled for - a short or long appointment- and have started to plan accordingly.
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It’s interesting that you mention the length of appointment. This is sometimes used as an excuse for secretaries or other non-doctor personnel to ask for private information when a patient is making an appointment. A thousand years ago when I was undergoing sensitive fertility treatment and didn’t want to discuss it with the world, the office receptionist started asking me why I needed one appointment or another. I asked why she needed to know, and she said it was to know how long to schedule it. I said, “what are my options for lengths of appointments?” and she was not pleased. Another time, I was trying to reach my doctor through the answering service and the rando paging person started asking when my last period was and I refused to engage with him about that. I think patients need more advocacy, not less.
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I always ask how long an appointment is before I go in. Also, if I have more than one thing to talk about, I ask if that is okay when I make the appointment.
Having the same providers over time avoids some of the dismissiveness folks are experiencing, I think.
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I haven’t experienced that. At the end of each appointment, the doc tells me when to come back, I go to scheduling as I leave and it’s set up. If I think I need an appointment, I call the nurse and talk through the issue.
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There was a study done many years ago and I’ll try to look for it If somebody really wants to see it, that said most patients expected/wanted to leave an appointment with a prescription. Sometimes the doctor didn’t think it was indicated or necessary, but it was Expected/desired by the patient, and may have affected the post appointment review/rating by the patient.
In my field, I sometimes experienced a patient coming in asking for a very specific test that may or may not be part of the evaluation process I used or might not even have in my “arsenal“ . There are a lot of tests available in my field , and not every test is used by everyone nor is everyone necessarily appropriate or indicated based on the referral question. Sometimes it was clear that somebody had asked a third-party about the testing process And was told to ask for a specific test. When that happened I would typically ask the patient or patient’s parent what the referral question was that we were addressing and usually discussed with them which test/procedures are used in my comprehensive evaluation. That usually was all that was needed. But it is a different situation than patients coming in asking for a lab test or an MRI, etc..
I wonder if that study informed what DS16’s first pediatrician did. At every well-baby visit, she got her pad and wrote something like, “Wonderful baby!” or “Keep up the nursing!” … I still have those notes and I miss her so much (we moved away).
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Much of the gatekeeping with requiring PCP before seeing a specialist is directly tied to insurance. The unknown paper pusher is telling the doc what type of tests they can do and what they can prescribe.
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I’ve had a total of 4 PCPs as an adult. Two of them quit because they were fed up with insurance company requirements. 
One went to work for a pharmaceutical company and the other left to head up an addiction recovery agency.
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