Avoiding Unnecessary Testing in the Age of Internet-empowered Patients

We have all encountered this particular patient scenario in the past: You walk into the exam room to see Ms. Smith and she describes her perception of a new symptom or problem. Just as you are about to start your interviewing process of gathering information about her complaint, Ms. Smith whips out a print out from WebMD and says the following, "...I think I have 'X' medical problem, doctor. I would like you to order the following test." To make the above situation more complicated, the patient has given you her perception of her symptom, has diagnosed her problem, and now she is attempting to get you to order what she thinks she needs.

This type of patient is practicing what is referred to as "cybermedicine." Certainly our patients have access to several very reputable online medical resources and if you do not think your patients are researching their medical problems, you are sadly mistaken. Depending on the class of patients you treat, these people are researching current practice standards and are very well read on current practice standards regarding their perceived "problem."

I openly embrace patients reading about their medical problems or symptoms online. I tell each of my patients that I want them to learn as much about their medical problems as they possibly can. This can be very helpful to the physician. First, once you deliver the correct diagnosis to the patient they can go home and read about and get answers to their most frequently asked questions. Second, these patients will perceive greater satisfaction with the treatment you provide to them (especially if they have already read about what is likely to happen).

However, the availability of online medical sites can pose a problem to the busy practitioner. First we must ask the patient to allow us to perform our history and physical examination. Second, once we have a working differential diagnosis, it is important to explain to the patient why we are thinking the way we think and the reasons for such. Most patients will arrive at cyber-diagnoses that are statistically uncommon or unlikely and additional time is needed to explain to the patient why the test they think they need is not actually needed at all. There is a potential pitfall here and one of two endings is possible. The physician can just order the test so the patient will be satisfied or the physician can relay their history and physical findings and explain why such a requested test is not needed.

Careful documentation is needed in both situations because ordering diagnostic testing must have supporting documentation to justify the request. Also, deciding not to order diagnostic testing would require documentation with justification as to why such testing is not needed.

At a time when healthcare spending is at an all time high, we must keep in mind the needs of the patient and we owe it to our patients to do only what is needed and prevent unnecessary testing. Additional discussions and explanations can help to alleviate worry for the typical patient described above and can prevent unnecessary spending of healthcare dollars known as practicing defensive medicine.

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