Doing Doesn't Always Equal Caring

The hardest part of my job as a nurse practitioner hands down is figuring out what patients want.  Some are looking for reassurance, some for a second opinion and others for a quick fix to a long-term problem.  Some patient's main goal is pain relief, others want to stick out their discomfort for fear of narcotic addiction.  But, over the years I've noticed one consistency among nearly all types of patients.  They want testing.

Regardless of the reason for their visit, most of the patients I see in the emergency department believe they should have testing of some kind.  Yes, there are a few with an above average awareness of the price of medical tests and procedures, but most patients don't believe they've gotten their money's worth without getting blood work, an X-Ray or a CT scan.

As a medical provider it's tempting to go with the flow, to order tests without thinking or explaining.  You diagnose a patient in their 20's with sciatica but order a Lumbar Spine X-Ray even though you know it won't contribute to your decision making.  You get blood work on the patient presenting with an insect bite and mild cellulitis because you sense their hesitation when you say "all you need is a prescription for Bactrim".  It's tempting as a nurse practitioner to order tests simply because your patients expect them.  If you don't order any labs, imaging or procedures patients often think you haven't adequately evaluated their problem.  And frankly, it's faster for you, the provider, to order labs or an X-Ray than explain why these testa are not necessary.

But what are we really giving our patients with all this unnecessary testing?  In order to avoid inconvenience and go with the flow, many times we are leaving our patients with hundreds of dollars in medical bills that could have been avoided not to mention the dangers associated with medical tests like radiation exposure.  Medical tests come with risks and cost and it is important we explain these to patients.  

We're all guilty of over-treating and over-testing at some point.  Let's not start pointing fingers.  Instead, let's embrace the growing trend of critically thinking before we mindlessly order tests.  While patients look for comfort, reassurance and answers in medical tests, often we as nurse practitioners can give them these things with our words and medical expertise alone.  Doing doesn't always equal caring. 

 

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Comments

Just moved to the Nashville area from out of state. The overtesting is even worse here. Nashville has clearly gotten fat and happy off of unnecessary exams and the patients, well, they love it. Its time to end this little addiction. In other words, be the change you seek

VIcedrn