Gus is a 72 year old friend of ours. He's in pretty good health except for the need to take blood pressure medications. He decided that his Medicare HMO was costing him too much money for what he was getting and decided to make a change. His monthly payment now is slightly higher, but his co-pays are enough lower that it offsets the increase. Unfortunately his existing doctor wasn't a member of the new HMO so he had to choose a new one. Standard procedure and not something he had a problem with.
The new doctor orders the usual round of blood work, and asked Gus if he'd take a stress test. Gus hadn't ever been called upon to do so but he thought it was a good idea, so he agreed. The stress test showed nothing unusual and he thought that would be the end of it until the next doctor's appointment. When he went for the follow-up, the new doctor recommended he have a number of other tests. He had x-rays, a cat scan, and a colonoscopy. He understood why the scope might be a good thing, but the x-ray and the cat scan didn't make much sense. Neither did the other tests that he endured whose names he's forgotten since they made no sense to him.
Gus had no symptoms of any diseases or other health problems. His heart function was shown to be normal and there was no fluid or anything that shouldn't be there in his lungs. He simply wasn't prepared for what the doctor asked for when he went to the second follow-up. Frankly, I don't think I would have been either.
He and the doctor were discussing the normal results on ALL of his tests when suddenly he asked Gus if he smoked. Gus hasn't smoked in 47 years. He told him he smoked for 5 years of his life when he was a teen and in his early 20s. To which the doctor responded, "I'm going to order an endoscopy, we need to make sure your smoking didn't damage your lungs or heart."
First off, all of Gus's tests gave normal results. Any of the tests Gus took would have shown a problem in those 2 areas in...well...a heartbeat. I am aware that an endoscopy will show damage from smoking in the esophagus, but in the heart and lungs? I don't think so. Neither did Gus. He refused. Doctor got mad and practically threw Gus out of his office.
The blood work didn't contain a single abnormal reading. All values were in normal range. Gus doesn't even have high cholesterol, which would negate the idea of a stress test since Gus suffers no shortness of breath or any other symptom of heart stress. However, since he does have high blood pressure it is a good idea. The colonoscopy is a good idea too although at 72, an argument could be made against it being a medical necessity. Cancer treatment at that age can be more deadly than the cancer itself.
What Gus has chosen for his Primary Care Physician is someone who practices medical malpractice avoidance and not medicine. These kind of "practitioners" are becoming more common and are among the varied reasons our medical care costs are out of control. Literally thousands of dollars were spent here on unnecessary procedures and the specialists that had to conduct the tests, read the tests and provide the Primary with the results.
Among the things Gus said to the doctor, which might be why he threw Gus out of the office, was that he'd be damned if he'll pay for ANY of these tests if the HMO decides they weren't medically necessary. Which could happen since as far as Gus knows, there wasn't any submission to his HMO for permission to conduct these tests. It may be that prior approval isn't necessary, or it might fall under all the "preventative" tests that insurance companies are now required to pay for.
Gus is planning on looking for a different doctor. Not because this doctor is necessarily a bad one, but because he got mad when Gus exercised his right as a patient to say no. Successful healthcare is always a partnership between doctor and patient. That partnership doesn't give the doctor the right to demand something just because it will make the doctor feel better. The purpose of this partnership is to help the patient to maintain his state of health, not to help the doctor stay out of court.