Patients, and Physicians, Need to Skip Unnecessary Testing

I had a 74-year-old patient today come in because of fatigue. She has seen her primary-care doctor, a rheumatologist, and a cardiologist - they all tell her she is fine. She still works part-time, volunteers, and watches her grandchildren. But she feels tired midafternoon and doesn’t have the energy she had 20 years ago. Really? Neither do I.

I had another patient, a 65-year-old, ask me to check her "hormones" because ever since she went through menopause, she has had a decrease in her libido.

We had a young man -healthy, feels well - concerned that he does not have enough muscle and that it must be due to low testosterone.

Fatigue, loss of libido, weight gain, hair loss…do all of these require hundreds or thousands of healthcare dollars to come up with “That’s life”?

Don’t misunderstand me. Bad things can cause fatigue. Things like heart disease, cancer, anemia. Bad things can cause weight gain, hair loss, and low libido, too. And there is certainly something to be said for improving quality of life even if no cause is found. But having said that, where do you draw the line at the million- (healthcare) dollar work up?

There is a gross shortage of endocrinologists in this country. Patients need to wait months to see anybody in our county. Some practices are so swamped, they’re not taking new patients. I have docs ask me to squeeze people in, people who truly need to be seen; people with blood sugars of 400, for example. But as I can only see one patient at a time, these patients have to wait, and it kills me when I see that my next new patient is here because her hair is falling out and it "must be" her thyroid, despite the normal tests her primary-care doctor did.

When we have limited healthcare resources - both time and money - we, as a society, have to say: That’s enough. No more tests. No more wild goose chase.

Patients don’t like having to get a referral from their primary. Many subspecialists don’t like it either. But I think it’s the right way to go. See your primary. Have the initial work-up done, then, when appropriate, refer to a specialist. And, not just out of exasperation because the patient insists.

Want to curtail healthcare spending? I’m all for tort reform (a whole other topic), but we also need to educate patients (and physicians) on appropriate testing. Just because a lab can be done, doesn’t mean it should be done.

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