Doctors Performing Unnecessary Medical Procedures

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 evidenced-based medical practice. Additionally, there may be disputes among medical professional if a proposed medical intervention is indicated or not.  Medicine is an art...

We inhabit an imperfect world.

Consider these examples and whether you think 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 physician requests that his patient undergoes a screening colonoscopy earlier than advised because he feels that the published guidelines from screening are too relaxed.  The gastroenterologist complies.
• An 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 disciplined?  Or, are these simply examples of imperfect practitioners functioning in an imperfect world trying to satisfy imperfect patients? When can physicians deviate from published medical guidelines?   Who draws the line?  How much flexibility should doctors be afforded to accommodate to patients, their families and referring medical professionals?  Are these examples of physician flexibility fair to the payors?

What is the definition of a medically indicated procedure?  This is more challenging than it seems.  Try crafting one and I submit that there will be many justifiable procedures that your definition would exclude.