WhiteCoat

Unnecessary Testing?

A patient was sent to the emergency department to have an ultrasound of her uterus performed.

She had been having abnormal bleeding which coincided with about the time her period was due – only it was a little heavier and lasted a little longer than usual. She decided the best course of action would be to make an emergency appointment with the gynecologist. She was seen the day before she was sent to the ED and the gynecologist performed an ultrasound in his office … which was normal.

The patient called the gynecologist the following day and said that the bleeding was still there, so the gynecologist told her to go to the emergency department for another ultrasound and some blood testing.

The patient arrived stating “I’m here for my ultrasound. Dr. Speculum sent me.” Since patients need orders for testing to be performed, the patient was given the choice of waiting to be seen in the ED or of getting a prescription from her doctor for the exam. She chose the former.

After examining her, we performed a pregnancy test which was negative and a CBC which was normal. So I told the patient she was likely just having a heavy period and that she could follow up with her gynecologist as an outpatient.
The patient demanded an ultrasound. After all, Dr. Speculum sent her to the ED specifically to have an ultrasound done.

So I called Dr. Speculum.

“Hey, it’s WhiteCoat here. Your patient is here with metrorrhagia and I’m trying to discharge her, but she insists that you want her pelvic ultrasound repeated.”
“Yeah. Can you do it?”
“Well what are we doing it to look for?”
“Fibroids”
“OK, well if she does have fibroids, are you going to admit her? Her hemoglobin is fine.”
“Noooooo. Discharge her after the ultrasound.”
“So then why … nevermind. If all you’re looking for is fibroids, weren’t you able to see that she didn’t have any fibroids on the ultrasound you did on her in the office yesterday?”
He must have really wanted that ultrasound by his response.
“Naaaaaaah. The ultrasounds I do in my office aren’t accurate.”
Allrightey, then.

The repeat ultrasound was still normal. I guess he was more accurate than he gave himself credit for.

Wonder if she’ll be referred back to the ED tomorrow for repeat pregnancy testing.

———————–

This and all posts about patients may be fictional, may be my experiences, may be submitted by readers for publication here, or may be any combination of the above. Factual statements may or may not be accurate. If you would like to have a patient story published on WhiteCoat’s Call Room, please e-mail me.

6 Responses to “Unnecessary Testing?”

  1. Dr. N says:

    I would have discharged her without the ultrasound. Unless there was a junior resident around who wanted to do a bedside just for fun. Definitely would not have sent her for a radiology ultrasound.

    • WhiteCoat says:

      This is one of those times where doing the right thing can jeopardize your relationship with the staff and the hospital administration.
      Plus, if he did miss something on his office US, then the patient suffers.

  2. Aesop says:

    I never get to hear the actual phone convos between our ED docs and the Dr. Chickensh*ts of the world. Thanks for the insight.

    Gotta love a practitioner who wastes time and money wanting you to repeat a test that will either
    a) demonstrate his earlier incompetence, or
    b) demonstrate his fiscal irresponsibility with the patient’s and ins. co.’s money.

    I get the medico-legal rationale, but in the event, a simple requirement that when a duplicate test is done, the the original testor either reimburses the patient and insurance company for the original test, or pays for the subsequent one out of his pocket, would nip this nonsense in the bud.

    This crap is as stupid as serial repeat CTs of the same headache, or multiple duplicate x-rays of the same broken arm at 3 hospitals because momma can’t seem to keep follow-up appointments.

    And all because the Dr. Chickensh*ts of the world are too chicken to tell patients that sometimes, things just happen, and repeating the same tests makes about as much sense as getting 12 estimates for bodywork instead of 3.

    If we spent as much time and brainpower managing ridiculous patient expectations as we did managing the Press Ganey scores those ridiculous expectations lay on us, we’d all lead happier lives and practices. And give better care to the remaining patients in the ED who actually need to be there.

  3. Mary says:

    And we wonder why health care is so astronomically expensive. What a waste.

  4. Fergie says:

    I have to agree with Aesop. Besides after reimbursing everyone, this physician would probably have written off that expense as an educational expense for a procedure in which he was not competent. Besides, why do your office US results have to be accurate if your only looking to ‘sell’ yourself by giving away videos and prebirth pics.

  5. No wonder the medical profession is losing face with the public. Personally I don’t always trust them. You have to learn to read between the lines

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