Doctors have several bad habits. They order piles of tests just to get a vague, unfocused view of a patient’s health. They order expensive and invasive tests to rule out the unlikely or extraordinarily rare. The worst “bad test habit” is when doctors order a test, which, no matter what the result, will not change what they are planning to do.
Why do doctors over order? These same people thought a 96 percent on the high school chemistry exam was a life-ending disaster. They believed that those four percentage points would be the difference between doctor and dogcatcher (no insult intended to my canine-trapping friends, just a comment on over-qualification). Physicians are prone to a standard of exactitude, which is not always reasonable, practical or merciful. They stay awake nights because of the minute possibility that there is a tiny chance of a small probability that an obscure diagnosis might be missed, because blood was not drawn, an x-ray not taken or an orifice not invaded.
There is not a lot of balance on the other side of the bed rails. Patients and caring family, especially in the invasive Internet era, are adept at expanding the differential diagnosis to maladies whose likelihood is remote. There is great deal of pressure on doctors not only to overturn every stone, but to dig five feet into the earth, no matter how unlikely a revelation or how probable a complicating scar.
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