I’m well aware of those biases, and I practice with the thought of always assume the patient is right and telling the truth. However once all the initial testing, exam, records scream negative, now you have someone that the best course of action is to help them understand they are not sick and truly healthy to avoid unecessary tests and complication. Surprisingly, some don’t like to hear that they are fine and healthy. Some Psych patients have much higher mortality, not because of being ignored, but because of over testing and complications.

Oh for sure, my comment is more towards people that won’t accept the diagnosis of everything is fine and no further testing is needed. Those people tend to yell, sue, go find some other doc, try chi blocking and crystals before they will talk to a therapist about their anxiety.

My comment about incidentaloma is more when you find something that wasn’t causing any true issue. Now what. You have to get another scan. But before that, there was no indication that anything was wrong because nothing was wrong. Now you’re stuck working and monitoring something that ends up being benign and would have been that way if you never look.

Same with any tests, there’s a rate of false positive to be aware of. When your suspicion is high, it outweighs it, but when it’s low and the test comes back positive, your stuck now and are often obligated to do unecessary work to prove that it was a false positive.

Not frequent, but enough to make you question are we truly doing no harm when we indulge people. Medicine is an art, at the end of the day its a mix of statistics and experience. Not everything has a clear cut or even a right or wrong answer. Do this long enough, and you’ll see things that have minimal risk turn into a clusterfuck.

For your question, yes I’ve seen minor things end up killing someone through sheer bad luck things can spiral out of control despite all the right steps being taken. Hence the inherent risk they mention of death during all informed consents.

Agreed

Because tests have harm. The average persone doesn’t understand what the sensitivity and specificity of a test means.

That’s terrible advice. I don’t know if any doctor that is “out to get you” by not ordering tests. Tests are not harmless. Improper testing can kill you. For example, you have a headache with no red flag symptoms. You keep pushing, some doctor orders an MRI and now you have what we call an incidentaloma. Some incidental mass that isn’t going to cause you any issue and is unrelated to your headache. Now you latch on to this abnormal thing, you worry about it, it affects your life. More scans and tests are done to figure out what this is. Eventually a biopsy is offered. Good news, it’s just some normal cells that happen to look funny on MRI, but completely benign. Bad news, the biopsy had complications and now you’re wheelchair bound for the rest of your life.

It’s thoughts like this where the “advocate for yourself” has turned into the “threaten the person that dedicated multiple decades of their life to help others to get what you want” that has lead to the insanely piss poor defensive medicine in the United States.

Tldr: refer every patient and order every tests until someone dies of bankruptcy or an unecessary complication because webmd.