A recent article in the Science Section of the New York Times examined a very prevalent and difficult problem for physicians, namely the right of a patient to "manage" his own diagnostic evaluation, in opposition to the opinions of his physician (Working Together on Costs, February 26.) The article maintained that patients often "do not want their doctors to take cost into account.............even if those (more expensive) options were only slightly better than the cheaper alternatives."
The issue, unfortunately, frequently results in a physician complying with a patient's request and ordering a potentially expensive diagnostic procedure (e.g. MRI, ultrasound, etc.) even if he feels it is not indicated - "adjusting" the medical record accordingly. Though, as the article maintains, it is the patient who bears major responsibility for this added cost to medical care, one cannot overlook the physician's complicity. The doctor often rationalizes that if "I don't order the test, Mr. X will find another physician who will."
Medical insurance should not cover non-indicated procedures. A patient, however, should not be denied the right to "purchase" a test. If, in fact, he insists on a non-indicated MRI, he should have the freedom to "buy" one. Perhaps there could be a new form of insurance policy, priced accordingly, for individuals who are interested in having the option of purchasing such highly-priced, non-indicated diagnostic procedures.
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