Tests

If you ask old doctors, they will unanimously say that the younger set of doctors relies way too heavily on getting tests.  Your history and exam should tell you the diagnosis, they say; tests are to confirm what you already know is there.  Spend more time talking to and examining the patient, and you will find out what is wrong with them easily.

There are many situations where I can do just that.  I spent years learning the art of history taking and physical diagnosis, and don't need that many tests.  That's why I get so annoyed when parents demand them. I really don't get that irritated when parents just ask if I shouldn't be doing some (unspecified) test.  But I do get ticked when parents with no medical training whatsoever (except, I guess, from Google U) think they know just WHAT tests I should be ordering.  News flash: that was also part of my training.  So was risk-benefit ratio.  That CT scan you're demanding won't tell me anything I need to know; and will expose your child to a shocking amount of ionizing radiation that will put him or her at higher risk of cancer down the road.  And if it is a belly CT, their reproductive organs will get irradiated.  You are putting not only your child, but your future grandchildren, at risk.  If I feel that a CT is necessary to care for your child, I certainly will not hesitate to get one.  But I don't like to get any testing if I don't have something useful to learn from it.  Please, let me do my job.

Patient satisfaction

I want to preface my post by saying that I snark and bitch about a lot of things.  It's the whole reason I created my blog.  But most of those things are relatively minor.  They don't diminish my love of being a doctor.  What I am about to talk about does diminish that love.  It makes me wonder if I am in the wrong career.

I spent years in medical school, residency and fellowship to learn how to diagnose and treat patients.  I put my adult life on hold while I did this, and went hundreds of thousands of dollars in debt for school.  After training, I spend hours in continuing medical education so I can keep up on the latest science-based treatments.

However, I seem to have wasted my time.  You see, now insurances have tied reimbursements to patient satisfaction.  If the patient satisfaction scores are good, the hospital gets paid.  If they aren't, no pay.  I want my patients to be satisfied that they got good medical care with appropriate communication.  But that isn't what makes high satisfaction scores.  That comes when families get what they want-regardless of what they need.  The parents of a child with functional abdominal pain (meaning belly pain without any identifiable cause) will INSIST he needs a CT scan.  Never mind that he has had 3 normal ones in the last 2 months.  Never mind that CT scans have a crapton of radiation, and the kid is being put at increased risk of cancer.  And their grandkids will have 3 heads.
The family of a kid with heartburn doesn't want to hear that maybe the kid should eat less fried and spicy food, and not eat at bedtime.  No, they want an endoscopy to find the problem.  Not only does the procedure itself carry inherent risk, but it usually requires sedation.  That only adds risk.
Parents Google their kids' symptoms, decide what they think the kid has, and what tests and treatments they need.  We, as medical professionals, are supposed to provide whatever is demanded.  When we don't, people complain.  After all, they are paying us to do whatever; we should do whatever they want.

I want to make myself very clear.  You are NOT paying me to just order whatever you tell me to.  You are paying me to assess your child, decide what diagnostic tests are appropriate, interpret them, and come up with a treatment plan.  If what you really want is to diagnose and treat your own child with help from the internet, write your own damn orders.  I have better things to do than take dictation.