Doctors Overtreating You?

Not every patient will be overtreated. But if you prefer minimal treatment, because you don’t have many conditions or because you like to let your body heal itself, the law and economics may disagree. For the doctor, it’s about income and the legal standard of care for health. For the patient, it’s about expense and the legal choice of whether it’s important for their own health. The game is on.

You see a doctor. You report what counts as a symptom or the doctor sees it. The law on standard of care applies (that’s the law against which claims of malpractice are judged) and besides there may be a revenue stream available. If the symptomatology (‘collection of one or more symptoms’) suggests a condition that needs verification or disproof, a test may be the way to find out, so the doctor orders testing. A diagnosis follows. If there’s a treatment available, the doctor orders it. Everyone working for the doctor now assumes that your job is to comply and carry out the treatment because, if they don’t agree, they don’t get any more paychecks, because the doctor doesn’t want any nondoctor pretending to be a doctor and there are job applicants waiting. So the patient has a potential conflict: obey or not, where not means contradicting the doctor and the staff, where they may dig in their heels and not give you critical information other than that you’re supposed to obey.

Self-diagnosis and self-treatment are potentially dangerous. If you have no trustworthy doctor available, do the best you can for yourself. This also applies to partial treatment: if a doctor prescribed three steps in their treatment of you, but you do only two, that’s a new treatment and your decision is your responsibility.

Serving your dependents, mainly children, is potentially even more dangerous, because they generally have less ability to communicate; and children’s anatomies may be more fragile. If you have no trustworthy doctor available, do what you can for them. When a doctor gets to look, their judgment may outweigh yours, in order that you won’t get accused by the government of neglect, for instance.

Seeing the doctor is free, they said? Ah, but it isn’t free. If you hardly ever go to a doctor, insurance to pay for office visits may cost more than paying cash to see the doctor at full price but rarely. If you have to take time off from work or if the boss thinks about firing you for excessive absence, losing your income is not free to you. It may be illegal to fire you for health reasons, and you might win a lawsuit, but it might take you a while. The boss likely had a pretext for firing you anyway, so you’ll have to prove that it’s a pretext in order for you to win. And if you win your job back, the employer, on their lawyer’s advice, will almost certainly find a way to terminate you within a day or so. You came in five minutes early? That’s insubordination, a violation. Out.

And the tests and the treatment probably cost money. Your money.

Checkups sound innocent and protective. They catch things you didn’t think to mention, or didn’t even notice. Treatment starts faster and is more likely to succeed. But a doctor on the radio said that if you had a checkup and got a “clean bill of health”, you didn’t have a checkup. That’s not a rare view. He was right that you can always find something. But is it something that would matter? Not always. I had a mild case of frostbite that was symptomatoic for years but then healed itself and now I don’t even remember which finger it was, or on which hand. Hernias no longer always require surgery; it probably took someone refusing a doctor’s order to get surgery to discover that it might not be necessary. Insurers offer checkups; maybe it’s because customers are willing to pay for that in their coverage but maybe it’s because insurers limit what a checkup will include. The Federal government, with a website interactive form, displays a list of tests it recommends for checkups (probably for where it’s willing to pay for precomplaint treatment) and, at least for me, it’s not a very long list. The U.S. military had a long list of disqualifying conditions and about half the males aged 18–26 failed when the standards were properly applied, but military life is more vigorous than office life.

None of this takes economics into account, because doctors don’t need to, not for us, anyway. They may for themselves, as many have to pay off school loans; the education is expensive and that debt probably can’t be discharged through bankruptcy. For the rest of us, the law provides for bankruptcy, which puts pressure on you to pay before that, because you don’t declare bankruptcy and get the court to discharge only the doctor’s bill while letting you pay all your other bills. The court, probably through a receiver it appoints, takes all your bills and assets under consideration, which puts all of your creditors into an uncomfortable position against you, and word gets around, and that may make it harder for you to get anyone to do business with you, such as by renting you an apartment. So you’re usually better off avoiding bankruptcy in the first place, and that means maybe refusing a doctor’s orders.

Economics is your issue. The doctor can say that it’s your health and nothing is more important and you have to do whatever it takes to take care of your health. But you have to consider health and economics together. Is the diagnosis of something you have no interest in treating (provided it’s not seriously contagious)? Once your diagnosis is on the record, would your employer tell you to hit the road and don’t call back no more? How about your business customers or your family? If you ignore economics and you can’t take care of yourself, your health probably goes down.

A doctor cannot judge your health by the same criteria you might. The only solution is a partnership: the doctor is an expert on health and you’re an expert on your overall needs. It’s your body. Maybe you’ll find common ground.