Over dinner this weekend, I asked two physician friends why they order so many tests. This question stemmed from the frustrations I’ve heard from patients about the mounting bills from unnecessary tests, and the urban myth that doctors are covering themselves against malpractice claims. While it may be true that some doctors practice defensive medicine, the larger reason for the testing is that medicine is a process of elimination or deduction. Most of us assume that when we walk into a physician’s office they can take one look at us and diagnose what we have.
As my physician friends stated, patients don’t always come in as walking conditions. There are times when symptoms don’t correlate to one specific illness. And then again, symptoms can also mask other things that may be going on with a patient. So if you show up with heart palpitations that may in actuality be a panic attack, you want your physician to make sure you’re not having a heart attack first.
The conundrum for physicians and patients, therefore, is how to manage costs when a diagnosis isn’t clear on the first visit. One of the first recommendations is not to be shy about the cost conversation up front so that it can be integrated into the diagnosis process. Here are a few discussion points that may help in deciding what you can afford, and what tests you should have to diagnose your condition:
- What tests would rule out the most severe condition that I could have?
For instance, if I have migraines what test would tell me if I have any bleeding in the brain? Chances are you want this test. - What is the most likely condition I have?
Ask your doctor if he or she can narrow down the diagnosis and identify the tests that are important now, and what tests can wait. - Is there a medical treatment for this condition?
Medicine and/or surgery may not provide sufficient relief for your condition. Find out if your condition could be managed by a lifestyle change. If your doctor has ruled out a serious illness, you may want to try and manage the symptoms through lifestyle changes, and forgo the tests. - Does this condition get worse over time?
If your condition is progressive, you can save money on future tests, medication, and doctor’s visits by taking preventative measures to manage your condition.
None of us want our health management to be reduced to just a financial decision. But there are ways to manage the costs of care by having an informed conversation with your doctor. It has been my experience that when I have these conversations, my doctors are receptive to thinking through what we need to do and the budget associated with it. We may still need to do some tests to eliminate what my illness is not and to find out what it is – we just don’t need to do all of them.
