Unnecesary Tests

6:11 AM

The never ending debate with regards to a raise in doctors consultation fees continues. The public still refuse can't understand why there is a need for it. All other expenses has increased, cost of healthcare is the last thing the public need. Of course, the easiest thing to tell the public is:

"Kalau tak suka nak bayar, pergi cari rawatan di luar negara"

I read a letter in The Star on Wednesday and I totally agree with Dr Ong Hean Teik.


I would like to highlight his point regarding unnecessary tests. When I was working in the hospital setting, I get a lot of patients and relatives asking for unnecessary and sometimes ridiculous tests for ridiculous reasons.
1. X ray of the eye for blurring of vision
2. Full Blood Count, Liver Function Test, Renal Function, Lipid Profile, Blood Glucose and chest X ray for fever for 3 hours

...and who can forget,
"My boy was admitted at private hospital 2 weeks ago for Influenza A. I have done my research (GOOGLE ONLY) and I KNOW WHAT INFLUENZA IS. I want a test RIGHT NOW!"

Bravo Mr Google, you have taught him well. But Mr Google didn't tell him which type of INFLUENZA A his boy had. Mr Google also did not give him any 'sense' as in COMMON SENSE since if sample is taken stat, the results will only come back weeks later. Although there are instant test kits available, you just can't get it for a registration fee of RM 1!

Back to the point, patients tend to want EVERYTHING for the cost of NOTHING. It just don't work that way. Patients come barging in to Emergency Department demanding for MRI for a TRO ligament injury of the knee. If you read Medscape, MayoClinic etc, there IS a role of MRI for diagnosis of ligament injury. But does it really warrant the cost. In a private hospital in the wettest place in Malaysia (a rather small town) it costs RM 700+ for an MRI TRO spinal cord injury. In the private center, it can be done stat or AS SOON AS YOU CAN PAY but in a government center, you have to be referred to a tertiary center. An appointment can take ages. (For a spinal cord injury, I REALLY suggest you get the MRI done if you have the money)

Sometimes, doctors do these test to save their bottoms. When something goes wrong, patients and their lawyers will always try to find fault by saying:

"Why was this test never performed on this patient"

Welcome to the realm of PROTECTIVE MEDICINE. Simply said, doctors now can't really focus on TREATING patients but spend a considerable amount of time to get lawsuits off our backs. At the end of the day costs are directly transferred to patients. Doctors tend to do everything under the sun. X rays, scans and tumor markers. Just have a look at the offers on Groupon. There are packages to screen all types of illness. All types of markers are taken....at the end of the day are these tests necessary?

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  1. Fight all they want, but patients have no rights to demand for any test if the doctor deemed unnecessary. Autonomy in medical ethics dictates that the patient has all the rights to decide each and every option of medical treatment as offered, but they can't demand for something that the doctor has yet to offer. So as long as the doctor does not seem fit, there is no offer for that particular test and the patient can't demand for it. Of course, private centers would happily offer all of them for other reasons altogether. I had a friend, a young lady in her 20's who was perfectly healthy and no family history of malignancy or any other possible risk factors, noted that one of her tumor marker was skyhigh. Ended up doing both OGDS and colonoscoipy as "recommended" by the health screening lab to a particular associate specialist. Of course, it is normal as expected, but there goes a few thousand ringgit for nothing although covered by the company. I wouldnt want someone sticking up something into my ass for no apparent reasons though.


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