The balance of medicine

While the linked article centers around Emergency Medicine clinicians, the gist of the article is applicable to any field of medicine. Not every symptom / condition requires the most expensive test or any test at all for that matter. The point being, just as one should be weary of clinicians who prescribe a pill for every issue, one should be weary of clinicians who refer patients for tests with every issue. Tests are not always necessary and in the case of multiple radiological studies, they can be dangerous down the line. Multiple and frequent tests can certainly increase healthcare costs as well. In my own practice, I’m very conscious in trying to minimize the use Cat Scans and X-Rays when not necessary while not withholding them in cases where they are indicated. For instance, x-rays for fractures to the nose and tailbone are almost never needed. Likewise, back x-rays in the setting of most injuries almost never yield useful findings. Even Cat Scans, especially in children, need to be carefully considered. With a good history and use of an accepted screening tool like the Canadian Head CT Rule, many head injuries do not require a CT scan. And in cases of suspected appendicitis in children, an ultrasound can sometimes make the diagnosis and spare the radiation exposure (though it can’t rule out the diagnosis, so a CT scan may still be needed). Sometimes, even a period of observation or having a patient come back for a second examination is an acceptable alternative. So, if your primary care provider is alway ordering tests, remember you have the right to take an active part in your care. Ask why that particular test, what will it diagnose, what can it rule out, and are there any alternatives that can utilized. A confident and competent clinician should not object or take offense to such questions.


A two way street: the clinician / patient relationship

The attached article is much more than about vaccines. The concept that a clinician’s patient needs to afford him or her a minimum level of respect and trust is paramount and applies to all aspects of the patient / clinician relationship. It’s not the same as “Doctor knows best”. Yet, as the author points out, there needs to be a degree of respect for the clinicians education and experience and that we are not simply an official to “rubber stamp” what the patient wants. When patients come in demanding an antibiotic or a CT scan for their illness, it needs to be understood that there are times the treatment they want is sometimes entirely inappropriate and can even be harmful to them. And in the case of vaccines, the withholding of treatment can be detrimental.