Trust is vital in a doctor-patient relationship so you have confidence in a diagnosis. * iStock photo
Trust is vital in a doctor-patient relationship so you have confidence in a diagnosis. * iStock photo

Question: What can be done when patients demand diagnostic tests that are not clinically necessary? 

These tests not only cost a lot of money, but some, like CT Scans, can be harmful if unchecked. How can patients be persuaded that they don’t need these tests? In reality, they will just go to different health professionals until they find someone who orders what they want.

Answer: Maintaining a balance between patient-centred care and medical necessity is a challenging task, which healthcare providers, and sometimes payors, usually have to confront. 

Currently, it’s largely the patient’s doctor who has to manage this difficult balancing act. It is easy to do when patients trust their physician’s judgement and are able to discuss concerns and make joint decisions. 

But it’s another story when patients’ natural anxiety leads them to information sources that overwhelm, confuse or misguide them. 

Healthcare providers also have to manage our cultural preference for “extras”, beliefs that “more tests equal better care”, and the knee-jerk tendency to think: “I paid my insurance premium so I’m entitled to the tests I want”. 

Unnecessary procedures

It’s a challenging process and, unchecked, has resulted in continuous, unsustainable increases in the use of diagnostic testing in Bermuda — not to mention the potential for patient harm due to inappropriate or unnecessary procedures. 

There is no magic-bullet for managing or solving this challenge to the health system or to individual patient care. 

Other jurisdictions have applied various methods to manage patient expectations, including limiting access via wait-times and strict application of clinical guidelines for test orders in a variety of ways. 

Such controls are rarely popular, but the alternative is uncontrolled utilization and unsustainable increases in health costs and insurance premiums. And in today’s economy, who would want that?

My doctor is great, but sometimes seems to err on the side of caution too much for me. 

Right now, for example, I have been doing some research on symptoms that have been bothering me for months and the treatment requires a referral to a specialist. My doctor won’t give me the referral though. What can I do if I disagree with my doctor?

Your relationship with your physician, dentist or other healthcare professional is vital. You have to work together in your best interest and this requires trust and confidence. Without it, you won’t feel safe in their hands, and you’ll likely not be the most amenable patient to them. When you have that relationship of trust with your doctor (or other health professional), it’s a good idea to heed their judgment regarding specialist care, tests and procedures — that’s what they’re there for. 

Communication is key

However, sometimes you may want a second opinion, and that’s understandable.

If you have that trust, you’ll be able to discuss with your health professional seeking a second opinion and agree on a course of action you are comfortable with. 

Communication is the key element in this situation. It is essential that you share your concerns and wishes openly with your physician. If you don’t have that level of communication or trust, you may want to consider a new healthcare provider. 

Nevertheless, in reality for most people, most of the time a general practitioner (GP) will be best placed to address your health needs and help you assess your options to determine the best course of action based on your circumstances. 

Answers supplied by Jennifer Attride-Stirling, CEO of the Bermuda Health Council