A friend has a mom and aunt with Lupus.
Her grandmother died from it, and was diagnosed right around… death.
She has some symptoms that could be Lupus, and as of yet she hasn’t had the ANA panel run that she suspects might be handy.
I am NOT looking for an armchair diagnosis, and I don’t even want an MD chiming in on the medical matter here; that’s not where I’m going with this.
Is it usual and customary for your family doctor to run tests that you request, even if your doctor hadn’t previously decided to run those tests?
My sister is a nurse and has routinely advised family members to request specific tests or bloodwork. None of them have ever mentioned a Doctor taking offense to it.
“OK Doc, I want you to order tests for Mycoplasma, Smilax and chestnut blight, and make it snappy” is unlikely to go over well.
On the other hand, after giving a good medical history and being examined, if you think particular relevant tests that haven’t already been ordered might be useful, your doc could very well agree to order them. Shotgunning tests to rule out unlikely things is after all a part of the medical paradigm (and partly explains why health insurance costs as much as it does).
In a strict sense, do tests even require a prescription or some other type of doctor’s order or authorization? Can you, say, make an appointment with an X-Ray clinic for a chest x-ray and a blood lab for a Complete Blood Count and just say that you’re going to pay yourself because your insurance won’t cover the tests because they haven’t been deemed medically necessary by a doctor?
If there’s a medical reason for it, I can’t imagine the doctor being offended. Particularly in the case of the OP’s friend,she should bring it up in the context of the family history and her own symptoms(which have presumably caused her to consult the doctor).
Something along the lines of “well, I’ve been having x, y, z symptoms. I did want to mention that I have a family history of lupus. Could we discuss doing some testing? I know the ANA test is one thing you look at”.
As long as she’s reasonable, vs. coming in and saying “I know I have the Ebola, I neeeeeeed a bone marrow biopsy!!!”*, the doc should be reasonable.
I happen to know of several blood tests that are appropriate to me, but aren’t part of the general screening panels or even routine for most patients. I don’t hesitate to remind the doc periodically so we can include them when I’m having other bloodwork done.
**
robert_columbia**, yes - labs etc. won’t typically do work without a medical order of some sort. I suppose there might be some that do very minor stuff (like a mail-order drug test or whatever), but in general, the test results aren’t much use to anyone without a medical person to interpret / take action. Hell, usually they won’t even tell you the results of things like scans even when they have the information right there.
yeah, I know bone marrow biopsy isn’t appropriate for Ebola. And if she did have that, she’d probably be bleeding out and/or dead, not hanging out in a waiting room!
This. I went to the doc for a checkup a couple of years ago. A couple of immediate family members have been diagnosed with a vitamin D deficiency, so I requested he check my vitamin D level. I have had a history of low testosterone; my last test was maybe eight years ago, so I requested another one. Doc agreed that both tests were appropriate and ordered them up.
Your friend should discuss her concerns with her doctor. An important part of the doc’s job is listening to the patient and reacting in medically appropriate ways to what’s said.
I’ve had a bunch of tests done recently, and all have required a prescription. Which reminds me - gotta’ find that prescription for the tests I’m getting done tomorrow. These are, however tests that are not done in the physician’s own office (they’re referrals for nerve testing). And some, like the EMG are (very minimally) invasive.
I think anyone presenting in a doctors office asking for a bone marrow biopsy would likely end up with a psychiatric referral*.
As someone who has had multiple marrow trephines and aspirations, I can hand-on-heart say it was the worst pain I have ever experienced. It’s impossible to accurately describe to someone who hasn’t experienced it first hand (as is any description of pain, I guess), but when I first saw this, it sharply brought to mind my own experiences.
*Obvious exaggeration, but I’m sure you get the point…
There are test requests that are reasonable thoughts given the information shared. There are those that are a bit silly but the test is simple and easy enough that if it let’s the patient (or the parent more often in my case) sleep at night to have it done, fine. And there are those that have a risk of harm or excessive cost, either from the test itself or from the false positive results associated with it (e.g. Lyme tests in low risk circumstances, or MRIs for headaches that are clearly migraines, CTs for a simple concussion …) - I don’t take offense at those being requested but I hope the patient does not take offense as I explain why I won’t honor the request.
I’ve never had a problem requesting specific tests, but my requests have always made sense.
I’ve also used labs which have arrangements with doctors to sign orders for anyone who pays for 'em. Probably not the most ethical arrangement, but when I needed a particular drug screen panel and hepatitis titers for nursing school and didn’t have insurance to pay for an office visit, I used 'em with good results. It’s the same lab that runs tests for my current doctor, in fact, so I don’t doubt the tests, just the ethics. Google will find you more info.
My GP has always been willing to run tests for me. For instance, I was discussing my multiple joint problems with my orthopedic. He suggested that I might want to be tested for Rheumatoid factor. Next time I was at my GPs getting blood work done, I asked him to run the RF test. He did.
(I was negative. Thanks for asking!)
-D/a
I think it probably depends a large degree on the specific patient/doctor relationship. If this is a patient who has no history of requesting needless tests or other hypochondriac-like issues then I would wager that the doctor would acquiesce. I know I have requested kidney and liver blood tests from my doctor when I’ve been concerned about things (I’m on several different medications). He had no problem with it at all.
“Doc, my testicles have migrated up to midway between my nipples and navel, and now seem to be shriveling. Why’s that?”
“Well, let me order this test…”
The upside to this is that you may get useful information leading to appropriate medical attention without having to depend on an M.D. to promptly respond to your concerns. There is plenty of downside, however. Not knowing about sensitivity and specificity of tests may lead you to dismiss a disorder prematurely, or worry yourself like crazy over an insignificant abnormality.* Abnormal-appearing tests can lead to further, more invasive and/or hazardous testing (whole body CTs, for example) that turn up additional “abnormalities” that turn out to be nothing after you’ve had unnecessary biopsies or excisions. Or people wind up with quacks who promise to fix nonexistent problems based on dubious testing (for example, urinary heavy metals assays).
*The more tests you get, the more likely it is that at least one of them will yield abnormal results just by chance (i.e. a complex metabolic panel or complete blood test showing an isolated result out of the normal range). I have a close relative who recently spent days worrying herself sick about a chance remark by a mammography tech about there being microcalcifications on her film. If I’d known, I could have told her that microcalcifications are a common finding on mammography, that only certain types of microcalcifications prompt concern for cancer, and even the great majority of those turn out to be benign. If you know what tests actually mean, you’re in far better position to evaluate them, but most people don’t possess that knowledge.
**I suspect that what drives some docs up the wall more than typical patients suggesting tests (or medications) are physician patients doing so. Awhile back I suggested my family doc prescribe a particular medication. He pointed out that another drug in the same class had a more specific profile and was probably better suited to me. I agreed, and he said “Thank you!!” I believe he was expressing sarcasm.
