setVeryLoud(true);Hopsital
half_fictionI’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.
OtakuAltairOn that note, why would they decline tests in the first place? You’re the one paying.
Because tests have harm. The average persone doesn’t understand what the sensitivity and specificity of a test means.
ZagorathThis is actually true. We have an over testing problem in the western world and it does cause some people harm, at least in the form of stress and anxiety caused by believing you have something that you don’t (due to false positives), or in some cases in the form of unnecessary operations and their associated medical risk.
And that’s without getting into the financial impacts, whether that be an impact on an individual or, in a civilised country, on the government.
That’s obviously not to say that nothing should be tested. Only that tests should be limited to cases with a heightened risk, be it someone showing symptoms (as OP obviously was, which is why this general problem of over testing is not applicable in this case) or being part of a demographic know to have heightened risk, as determined by experts and medical best practices.
Overuse of diagnostic testing in healthcare: a systematic review
Background Overuse of diagnostic testing substantially contributes to healthcare expenses and potentially exposes patients to unnecessary harm. Our objective was to systematically identify and examine studies that assessed the prevalence of diagnostic testing overuse across healthcare settings to estimate the overall prevalence of low-value diagnostic overtesting. Methods PubMed, Web of Science and Embase were searched from inception until 18 February 2020 to identify articles published in the English language that examined the prevalence of diagnostic testing overuse using database data. Each of the assessments was categorised as using a patient-indication lens, a patient-population lens or a service lens. Results 118 assessments of diagnostic testing overuse, extracted from 35 studies, were included in this study. Most included assessments used a patient-indication lens (n=67, 57%), followed by the service lens (n=27, 23%) and patient-population lens (n=24, 20%). Prevalence estimates of diagnostic testing overuse ranged from 0.09% to 97.5% (median prevalence of assessments using a patient-indication lens: 11.0%, patient-population lens: 2.0% and service lens: 30.7%). The majority of assessments (n=85) reported overuse of diagnostic testing to be below 25%. Overuse of diagnostic imaging tests was most often assessed (n=96). Among the 33 assessments reporting high levels of overuse (≥25%), preoperative testing (n=7) and imaging for uncomplicated low back pain (n=6) were most frequently examined. For assessments of similar diagnostic tests, major variation in the prevalence of overuse was observed. Differences in the definitions of low-value tests used, their operationalisation and assessment methods likely contributed to this observed variation. Conclusion Our findings suggest that substantial overuse of diagnostic testing is present with wide variation in overuse. Preoperative testing and imaging for non-specific low back pain are the most frequently identified low-value diagnostic tests. Uniform definitions and assessments are required in order to obtain a more comprehensive understanding of the magnitude of diagnostic testing overuse. All data relevant to the study are included in the article or uploaded as supplementary information.
Agreed