If a patient wants a colonoscopy done, and it’s not medically indicated, should the doctor still do it?
If the physician complies with this request, has he or she
committed an ethical breach? Should the
medical board or some other disciplinary agency be notified to investigate?
Of course, in a perfect world every medical procedure or
prescription would be advised only if it is medically indicated. But the world is not perfect and there are
instances when good physicians may deviate from established medical dogma.
Consider these examples and whether you think that a
disciplinary response is appropriate.
- A patient is due for his next screening colonoscopy in 2 years, which would be 10 years since his last exam. He approaches his doctor with anxiety because his coworker was just diagnosed with colon cancer. He asks that a colonoscopy be scheduled now. The doctor agrees.
- A patient wants his colonoscopy performed in December, after his deductible has been satisfied, rather than wait until July of the following year when he is officially due for his next exam. The physician accedes to this request.
- A referring patient requests that his patient undergoes a screening colonoscopy earlier than advised because he feels that the published guidelines from screening are too lenient. The gastroenterologist complies.
- A frail, elderly patient has some modest bowel concerns. The gastroenterologist does not suspect that these symptoms portend a serious issue. The patient is accompanied by her two children who are firm in their desire that their mother undergoes a colonoscopy to assure that all is well. The patient grudgingly agrees to proceed. The doctor schedules the procedure.
So, should these ‘rogue doctors’ be reined in and
disciplined? Or are these simply examples
of imperfect practitioners functioning in an imperfect world trying to satisfy
imperfect patients? Do you agree that
strict medical criteria should not be the sole criteria that physicians use?
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