PROFESSIONSome patients ask too much, or do too littleEthics Forum. Sept. 2, 2002. Scenario: Should you give patients what they want, even if they don't need it? Many people, concerned by stories they have seen on television or read in newspapers, approach physicians with demands for medical tests or procedures that appear unwarranted. Tales of full-body CT scans that have uncovered tumors or aneurysms have triggered the latest rash of such demands. How might a physician respond in a manner that both acknowledges the patient's concerns and preserves the patient-physician relationship?
Reply: Rather than electing to ease a patient's fears by ordering an unnecessary procedure, a physician can address concerns by exploring why the patient wants the test. Researchers have noted that few physicians urge patients to talk with them about the issues that give rise to apparently unfounded concerns. A seemingly trivial request may be grounded in an actual physical concern. The request creates an opportunity to review information contained in (or missing from) a patient's medical history or in a family history. Often former medical problems or the recently diagnosed illness of a relative are among the reasons for the request. Physicians should ask whether a particular physical symptom provoked the decision to see the doctor. If so, these symptoms can alert physicians to medical concerns unrelated to the patient's initial request and may indicate more appropriate and specific tests or treatment that is more beneficial than that requested by the patient.
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