DRHOOK- Treat the patient: Lab work, tests not first priority

the handsome doctor John Hong of CharlottesvilleLayoffs are all about numbers: profit and losses. When the losses are more than the profits, jobs are lost. The people I know who have been laid off pretty much know it wasnt personal. In fact, the people who laid them off are often anonymous executives who dont have a clue about their employees.

Nonetheless, its hurtful to be let go after years of dedicated service. What has happened to relationships and loyalty?

Does this also apply in health care? Has the art of medicine come down to treating numbers and providing test results?

Treat the patient, not the numbers– I learned that throughout medical school and residency, and I still try to act on it. This doesnt mean I ignore a drastic lab result or a tumor visible on a chest X-ray if the patient feels fine. It means that I take the patient into consideration when deciding upon further work-up and treatment. Maybe an 85-year-old woman doesnt want the spot on her liver visible on a CT scan to be biopsied.

However, some doctors wont even look at a patient until certain studies or labs are done. They want to look at the MRI or see the lab values before they will allow the patient to make an appointment.

I cannot refer patients to a few specialists because they wont schedule the patient unless they have had a test done within six months of the time of the appointment. Thats a kind of catch-22, because how do we know the patient can get an appointment within six months of the study yet to be done?

So, Mr. X, you had your MRI done today? Well, the next available appointment is in six months and one day, so you will have to repeat your MRI and call us back.

Recently a patient asked me to be referred to a particular surgeon. Guess what? We couldnt refer the patient because the painful study was done eight months prior. Even though we told the office the patient was in pain and repeating the study was going to make a difference, they said no.

I asked, Cant the doctor at least evaluate the patient? I could almost hear the doc thinking, Talk and examine a patient? I dont remember the anatomy of a shoulder or how to examine it. I need studies!

In defense of tests and studies, doctors are almost obligated to perform them; otherwise, the patient might feel he/she is getting sub-par service. Since modern technology exists, we all expect to use it. And in these days of almost automatic malpractice lawsuits, most doctors over-order tests to cover their MD buttocks.

We cant really diagnose high cholesterol without lab tests. However, a primary care physician isnt going to say, No, I wont see you unless you have your labs faxed to me first.

There are other things to look at, such as exercise, diet, whether the patient has angina or shortness of breath, smokes, or has a strong family history of heart disease. And just because someone has bad cholesterol doesnt mean a medicine is the best thing for that person. Diagnosis and treatment really is an individual thing.

Another problem is that some illnesses are not covered by insurance. So if an obese person wants to talk to an endocrinologist or bariatric surgeon, either the patient has to pay in cash, or more than likely the health insurer makes the doctor eat the cost.

But if that obese person has high blood pressure, diabetes, or something related to the obesity, then the visit might be covered.

Tommy Tutone sang, Jenny Ive got your number– 867-5309. Unfortunately, the art of medicine is becoming this way. Patient, Ive got your number– 555-NOPE!
Dr. Hook cracks a joke or two, but he's a renowned physician with a local practice and an interesting website, drjohnhong.com. Email him with your questions.