this post was submitted on 31 Jul 2023
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[–] [email protected] 137 points 1 year ago (22 children)

I've never tried this, but advice I've seen online is if your doctor won't order testing, ask them to note in your chart that they are declining testing. Apparently the implicit threat of a lawsuit if they're wrong is enough to kick at least some of them into CYA mode.

[–] Goseki 7 points 1 year ago (6 children)

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.

[–] [email protected] 8 points 1 year ago (1 children)

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.

[–] Goseki 3 points 1 year ago

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.

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