Occasionally a patient will ask that a diagnostic test be performed for which there is no medical indication. A clinician needs to respond to such a request appropriately.
A number of questions need to be asked before responding:
(1) who is actually asking that the test be performed?
(2) why is the test being requested?
(3) how much does the patient want the testing performed?
Adverse consequence if the test is performed:
(1) very low but possible adverse reaction to specimen collection
(2) low risk of liability (especially if the test result is abnormal)
(3) disciplinary action to the physician if the test is paid for by an entity other than the patient
Adverse consequences of not performing the test:
(1) patient alienation
(2) very low risk of liability in the event that the test would have been beneficial
Most payers require that all diagnostic tests be medically necessary. If the test is determined to be unnecessary then the patient may have to pay for the test. If the physician performs a test knowing that it is not necessary, then there may be negative feedback from the payer.
Course of action:
(1) Determine if there is a medical necessity to perform the test.
(2) Inform the patient of the facts.
(3) Offer to refer the patient if a second opinion is desired.
(4) Suggest that the patient self-refer to a diagnostic center if allowed by local regulations. In this situation the patient would be responsible for the cost.
(5) Document the discussion in the medical record carefully.
