Ethics 101

1 How do you get around ethical questions such as when a doctor recommends a procedure that you know is not necessary for a patient to have? I have found myself walking personally into this issue several times this year in the course of my own care. My way of approaching it would be to discuss it with the doctor first. Has anyone had this issue?
I generally talk to the person ordering the test/procedure/surgery/whatever and find out what their rationale is. I also encourage my patients/families to be informed consumers. I encourage them to ask, "What difference will this make for me? What will change about my care as a result of those test results?"And if it's really uncalled for, I've called the bioethics committee. Got overruled. But I was able to live with myself at the end of the day because I did all I could do.

I'm trying to imagine a scenario where it's not arrogant to "know" that a procedure is not necessary. Enlighten me?

Your own care? Did you discuss it with the doc who ordered the tests?

Thanks, wooh. I like the second line there. I also try to figure out what the rationale is...thanks for your insight.

If I'm there I tell them. I have no scruples about it. I don't work for any surgeons.I tell patients and families that surgeons don't get paid not to do surgery.A second opinion is a pretty good idea if the problem isn't acute and life-threatening.

To Orange Tree: please advise whether or not you prefer patients to be active in their healthcare, or just to have a passive patient on your hands who doesn't want to learn about their condition and treatments, and who most likely will return to the hospital at a later date as the result of being noncompliant? By the way, the doctor in this case attempted to twist a patients arm to have a procedure which is outdated and carries many complications. I don't see anything arrogant about a patient questioning a doctor. I do see a problem if the doctor behaves in front of the patient as though he was a two year old who didn't get his way when the patient said no.

I'm not really seeing an ethical conundrum here. Physician recommends xyz procedure. Assuming that the patient is alert and mentally capable, the patient is free to ask questions, get clarification, and/or refuse the procedure.The purpose/function of a trained physician (or other provider) is to evaluate a patient's condition and decide the best way to treat it. "Best" is of course a judgement call. If the patient finds the proposed treatment objectionable for some reason, then can they can seek alternative treatment or choose not to treat the problem.

Inquiring minds want to know. What in the heck is this outdated procedure that carries many complications? That information would make your question a lot clearer.

I've asked if I could try doing something more conservative for a period of time; if things aren't better, or get worse, THEN I'll give up and do the *******' test

a 2nd opinion is always warranted...unless the 1st opinion's suggestion is obvious.when i've seen drs suggest certain procedures for a pt, i've been known to show my disgust.ok. i did it one time, and i know it was unprofessional...but surgery for a 97 yo on hospice? really??????that said, i agree about hearing what the doc is thinking, his rationale.if you feel knowledgeable enough to deem it unethical, then go a step up.encourage pt/family to seek 2nd opinion, independent of the med'l group/hosp dr is a part of.bring it to the top if necessary, as wooh stated.just keep in mind, some ethics committees may have agendas, as well.leslie