Q: What are the patient's rights in accepting or rejecting their primary care physician's or specialist's recommendations for tests? I know some tests are necessary, but what about numerous requests for tests that seem to the patient to be (pardon the pun) overkill?
A: Included on a list of patient rights in the American Medical Association code of ethics are these rights:
For patients to be provided information from their doctors and to have the opportunity to discuss the benefits, risks and costs of both appropriate treatments and forgoing treatment.
To expect their doctors will guide them on what they believe is the best course of action.
To make their own decisions about the care their doctors advise and have those decisions respected.
Still, having the right to say no isn't quite the same thing as making a tough decision to reject your doctor's professional judgment about your health.
On one hand, even some doctors think at least some medical care is unnecessary. Research published in 2017 in the journal PLOS One suggested nearly 65 percent of doctors surveyed believed at least 15 to 30 percent of medical care is unnecessary based largely on malpractice fears, patient demands and difficulty accessing prior medical records.
On the other hand, doesn't it signal a certain lack of trust and confidence in your doctor if you reject his or her advice?
The way Christie Clinic's DR. BEN JOHNSTON sees it, a good doctor-patient relationship can help avoid disputes over doctor-recommended care. And when a dispute does arise, he said, there needs to be a good, open discussion in which both the doctor and the patient listen to what the other has to say.
Sometimes patients express realistic concerns, such as insurance coverage for certain tests and how much it will cost, Johnston said. His approach is to listen to those concerns, explain why he believes a certain test is necessary and provide information about the risks versus the benefits and the limits of the test, he said.
That holds true for whether the test is a preventive screening or whether a patient has symptoms that need to be explored, Johnston said.
Sometimes patients also object to a test based on medical information they've read online, which, again, calls for a good doctor-patient discussion, Johnston said.
"If you are going to read anything online, I'm personally OK with it. It makes them better informed, but with this monstrous caveat, that whatever you're reading has to be true."
For an accurate source, he advises using emedicine.com, an arm of the physician resource Medscape.
Two more things to keep in mind: Johnston said doctors don't generally order tests they think are unnecessary. And he doesn't know of any doctor who would terminate a relationship with a patient because the patient rejects the physician's advice.