[Rich_in_Tampa]

Quote:

Originally Posted by SoonToRetire Gee, that sounds like the medical merry go round I've been on lately. I would much rather have the option, as a patient, to assume my own risk of not doing a CT and missing some rare abnormality, versus having the CT and possibly starting a useless wild goose chase. As a patient, however, I don't recall ever being given that choice, I'm just told that I'm being referred to such and such a specialist for further tests and diagnoses. I suppose I could opt out of further testing, but it's difficult when one doesn't have the information on which to make an individual decision on the risks. Of course, there are clear cut times when I need a doctor to tell me that I have a condition that needs to be treated. But so many other times just seem like CYA fishing expeditions and lead to needless worry and carry their own risk.

Well said.

I involve patients in these decisions all the time. I tell my students that I never intentionally practice defensive medicine, but I often practice defensive documentation.

"Discussed risks and benefits of CT including incidental findings leading to further testing, small possibility of overlooking bleeding or other serious conditions if we fail to do this test. Good understanding was expressed and pt prefers to omit the test with good insight. To call at once for any unexpected symptoms."

I have no idea if that would protect me (or the patient), but it's how I do it (stress tests, PSA test, and lots of others are common examples).