Medical Code: The Shotgun Approach

November 25, 2008

The Shotgun Approach:
Praise the Lord & Pass the Ammunition

As mentioned in my "Mission Statement" doctors must have a valid justifiable reason for making the choices that they make. The absurd, to illustrate a point:

If you come to a doctor with a stubbed toe and she/he orders a chest x-ray, I think we can safely assume that is not good practice.

It is a generally held belief that a doctor should be able to make 60-80% of diagnoses based on a careful and thorough history of present illness and physical exam. It's amazing how often a patient actually spits the diagnosis out right at you and may be quite unaware that they are doing it. Unfortunately, too many practitioners have become utterly reliant on laboratory (e.g. blood work) and imaging (e.g. x-ray) tests to make the diagnosis for them. This is absurd considering the limits of such tests.

Now, I start by examining the practitioner but, to be absolutely fair, I have to look at the other side: the patient. Patients come to a doctor hoping for answers, hoping for help. They perceive tests as the ultimate in a doctor working for them, and the more the better.

Unfortunately, using a shotgun approach (ordering every test known to man for screening*) is not only unhelpful but may also work against you. The more tests you order the more you put yourself at risk for lab error. This isn't just anecdote, this is fact. In fact, the odds of a false test result increase literally exponentially with the number of tests ordered.

So please, I implore my future colleagues to rely on their skills rather than some test. Be prudent and judicious in their use. Challenge yourself as a physician, think things through. And I beg my future patients, abandon the "more is better" attitude. Don't ask for unnecessary tests and work-ups. If a doctor says that you don't need them, don't feel abandoned. He/she is actually helping you more than you know.

*More on screening tests in the future