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Can Patient Autonomy Go Too Far?

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On a regular basis, physicians receive calls or communications from patients who want to schedule their own scope examinations of their colon or stomach regions.  These requests are solely from patients without any input from medical professionals.  A few days before writing this, a patient contacted our office to ask if we would perform an scope exam (EGD) of the esophagus and stomach regions at the same time as his previously scheduled colonoscopy to evaluate his cough.  This was his idea.  No physician or medical professional was involved.

We summarily decline these requests.  If one of my own patients is making a scope exam request, I may acquiesce but only after having a dialog on the issue.  I do not extend this leniency to patients I do not know and aim for access onto my scope schedule.

I believe that patients should not be permitted to order diagnostic tests and procedures.  While this may seem self-evident to readers, I surmise that many of today’s informed and empowered patients have a different view.  Ask any physician how often a patient asks for specific lab testing, a CAT scan, an antibiotic or a consultation with a specialist?   This may change.  Who can predict or even imagine how profoundly artificial intelligence will disrupt the medical profession?  So many technologies and capabilities today would have been deemed impossible earlier in our lifetimes.


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Let’s play out the example from my opening paragraph of the patient requesting an EGD for a cough.  Here are a few potential pitfalls.

  • The probability that the EGD exam will explain a cough approaches zero.
  • Has a medical professional evaluated the patient’s cough for the usual causative suspects?
  • Should I willingly perform a medical procedure that is likely not indicated?
  • Isn’t performing an unnecessary medical procedure under any circumstances an ethical breach?
  • Wouldn’t agreeing to perform the EGD validate the patient’s belief that he has this authority?
  • What would my legal exposure be if a medical complication occurred?  (Hint:  very high!)

The practice of medicine is a high stakes discipline.  Doing it well requires knowledge, experience and honed judgment.   I realize that shared decision making is now embedded in the medical zeitgeist but we should also keep in mind that one side of the doctor-patient relationship is the actual medical professional. 

If you were on trial, would you expect to direct your attorney to adopt your legal strategy?  You might have the right to do so but I surmise that this would be unwise.  Recall the adage attributed to Abraham Lincoln that a man who represents himself has a fool for a client.

To readers who disagree with me, fret not.  ChatGPT and its descendants are just around the corner. Then, you won’t need a doctor at all.

 

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