Mental Health

Doctor's Conundrum: Please Patient, or Give Correct Diagnosis?

| by

Recently, a Dr. S. Brown wrote in Medscape:

"A while ago, a patient called me to say he couldn't believe I charged him $50 to tell him he didn’t need a chest X-ray. He was a was a 30-something male patient who had had a cough for a few weeks. He had a short visit, wherein I took a brief history of his illness, did his vital signs, listened to his lungs and told him he probably had a viral bronchitis but didn’t need antibiotics or a chest X-ray; his condition would improve with time. He felt he had been overcharged.

I find it increasingly frustrating to do the right things for patients who feel they are being shortchanged if they don’t leave with either a prescription or a requisition. I attempted to explain to him that I make my living mainly by giving professional advice, not by pushing drugs or ordering tests."

The fact that patients seem to demand a prescription when they go to the doctor has led to such things as the overuse of antibiotics. Viruses, which cause a signicficant percentage of infections, do not respond to them; only bacteria do. Doctors want to keep patients happy, so often will prescribe them even when they know the patient has a viral infection which will clear up all by itself.  The over-prescription of antibiotics, in turn, has led to the emergence of highly antibiotic-resistant bacteria.

Psychiatrists have taken a lot of heat in some quarters for being overly quick with a prescription pad.  If you go to a psychiatrist, you are in fact very likely to leave with a prescription whether you need one or not.  However, some of this situation is accounted for by patients who demand a medication to solve every problem.  It is not due just to psychiatrists being overly enthusiastic about the wonders of modern medicine.

Not that wilting in the face of a patients' demandingness is a legitimate excuse for the doctor to prescribe drugs for everyday problems in living.  Doctors should be prepared to give patients their honest opinion, whether the patient likes it or not.  If the patient gets upset because the doctor says they need individual or family therapy - or perhaps even no treatment at all - then so be it.  If the patients go away angry and see someone else to get a different opinion, that is their perogative.  There is enough legitimate business to keep psychiatrists busy.

Nontheless, what happens if such a patient goes on some website and gives the doctor a bad review, or creates some other kind of negative publicity?  The government has even discussed the use of patient satisfaction surveys for evaluating a physician's "performance."

What if an insurance company demands a diagnosis or refuses to pay for the doctor's negative evaluation?  I do not know for sure if any managed care company has tried to pull that trick, but I have heard tell about it. 

If that happened to me, I would call the insurance company and demand payment, and immediately resign from that insurance company's provider panel if turned down, because I have to spend time doing an evaluation to find out whether or not a patient needs treatment.  I deserve to be paid for my time.

I can nonetheless appreciate how some doctors can succumb to the temptation to take the easy way out and give patients and insurance companies what they seem to want.  Medicine is a business, and alienating potential "customers" can be a poor way to stay in business.

The medicalization of behavior problems has may causes, and the demands of patients for quick and easy solutions to every problem has to be counted among them.