Frustrated with Drs ordering unneeded test

[racing-mom4, BSN, RN]

I posted last week that I was upset about my 81 yr old grandma needing a bone marrow biopsy due to a low sed rate and low HGB.

Well results in and perfectly fine/normal. Tx: 2 iron pills a day with meals.

Does it matter that I suggested "well lets just have her take an iron pill Qd and see what her HGB is in a month?"...no...cause Dr said, grandma must do. I argued with my Aunts (who of course can do no wrong and know all) and Aunt said " I know this Doc he wouldnt order the test if it wasnt needed"....Yes Iam glad she is fine, but did she really need to go through that?

How many times a day do we see patients having un needed tests/procedures? A ton. I understand the logic that to CYA of the Doc they must suggest these test so that 6mos later the family doesnt come back and sue because Grandma had aplastic anemia and did not get proper tx. But really are consents true consents? Do Drs explain here is what may happen with procedure, here is what may happen with out?

So it is really frustrating to me. We had a 97 year old ahlz/unable to walk/talk/eat pt in the other day who had a peg tube placed, it was discovred she has gallstones, so lap chole done, 2 days later she died. Was that surgery needed?

[classicdame, MSN, EdD]

how many times? Probably a little more than the times MD's get sued for NOT investigating further. It is a bad situation for all concerned.

[racing-mom4, BSN, RN]

how many times? Probably a little more than the times MD's get sued for NOT investigating further. It is a bad situation for all concerned.

True, very true. Even my own personal family doc has ordered what I feel are un needed tests sometimes and I quesiton him, tell him I dont really think that is needed and he will agree and no test. Almost like they must document their plan then document pt refused to cover self. I understand it, the frustration comes with I dont feel they are explaining enough to the non medical folks. On the flip side, I know that takes alot of time and some times no matter how much education you give people still dont get it.

The other night I had a pt with a CVA, her sister didnt want to hold her hand, I told her pt could hold hands and seemed to enjoy it, sister told me "I dont want to catch what she has". I then explained what a CVA was, in great detail, sister looked me right in the eye and said "at my age I cant risk catching it"....went right over her head.

[pattycakeRN]

The other night I had a pt with a CVA, her sister didnt want to hold her hand, I told her pt could hold hands and seemed to enjoy it, sister told me "I dont want to catch what she has". I then explained what a CVA was, in great detail, sister looked me right in the eye and said "at my age I cant risk catching it"....went right over her head.

Is this person of child-bearing age?

Why can't they require a license to have children?

I have so many questions.:stone

[NeosynephRN]

For every ten patients that go through an un needed test that reveals nothing...there is the one that it would pick up on something and save their life...does that completely justify it no....

Doc's are working for the ultimate CYA...I mean who is more likely to sue..you when your G ma went through this test and is ultimately fine or the next pt they do not test...has leukemia and you lost time in treatment..and possibly the outcome was changed..

[SmileyCNAII]

I can see both sides of the coin. My husband died b/c his Dr. did not pick up that he was in early stages of heart failure. On the other hand I work in the ER and see it first hand every day, people who probably do not need it are given CT's (we do a boatload everyday) and even MRI's...The answer??? I wish I knew.... I had a Dr from India tell me that all surgery will eventually be done overseas, something to do with not being able to sue for damages over there?? Peace....

[StrwbryblndRN]

I agree with SmileyCNA. You never can tell. I have one nurse who discovered a lung nodule when she had a chest x-ray. She thought the x-ray was a waste of time because she had a cold and they wanted to r/o

pneumonia. She did have a could but low and behold she ended up having a lobectomy.

I am not fond of certain surgeries and interventions for individuals who do not seem to qualify or quality of life gets worse. But I can't argue tests that may uncover a potentially deadly problem.

If having possibly needless tests done saves a life, then I say to the MD's order away. It is a balancing act for them and I do not try to know how to do it.

You never know what can happen.

[MIcrunchyRN]

Yup I think some doctors order tests that aren't needed... but then you get others who don't listen when a patient says something is wrong and it is. and its too late.

My husband has rare kidney condition. One doc did nothing.. said ah take these meds you'll be fine. Another ran a bunch of test low and behold its a REALLY rare condition.

So when an ER visit has been needed for his condition and his K+ drops to really low levels there they are wanting to do a CT scan because he's confused and spinal tap because he has a headache when clearly the 50 dollar lab test for K+ show the problem. The ct and spinal tap aren't needed and docs cannot seem to trust people who know their own bodies and diseases better than they do.

[oramar]

I understand your frustration. I think the problem lies as much with the fact that your family refused to listen to you as with the MD. Lucky for me my 84 year old mom with dementia gave me her medical power of attorney. I have refused many, many proceedures and test and medications that were to me unnecessary. I swear she is so much better off, some of the stuff they wanted to do was so invasive I am sure it would kill her. PS I did find a primary care physician that agrees with me. Had to try a couple different docs before I had one that does not poke and prod to often.

[santhony44, MSN, RN, NP]

As a provider, I can see both sides, too.

Sometimes it's a real balancing act. I try to explain things in such a way that the patient and/or family can make a realistic decision. What the findings are, what the possible causes are, what tests can be done, and what's involved in these tests. I also let them know that they can say "yes" or "no" to the tests or procedures.

I find that people usually make pretty sensible decisions once they have all the information. If Granny is 85 and frail/debilitated, once she and the family understand what's involved, for example, in a colonoscopy prep, what the scope is looking for, and what might happen if something is found, then they may be comfortable in declining the procedure. OTHO, if Granny is 85, still gardens, golfs, travels, dances, and plays bridge, she may say sure, let's go for it.

It takes time on the provider's part, and of course you have to document well that you did have the discussion, discussed risks/benefits, and so forth, but you've let the patient and family make the decisions with the information that the need.

I have the same approach with mammograms in older ladies. When I discuss those, I ask "Would you want to do anything about it, if something were found?" If the answer is no, then there is no need to do the test.

[pattymac]

The doctor said that it was time for my 87 year old mother in law to have a bone density test. I called and said "why?". They said, "because we do it once a year and she is on medication for osteoporosis". Guess what? She has never had one before and has never taken medication for osteoporosis.

It's sometimes all about the money.

[DanFNP]

We are living in the age of hungry lawyers. We have to always cover our butts when ordering tests, procedures, etc. Of course, one should never blatantly do things that will cause harm. But certainly, its better to be safe than sorry...or do too many tests than not enough and face the consequences.

Dan, FNP