I am fortunate to not only practice medicine and train physicians for the future. However, jobs in my field (radiology) have become scare. One of my residents return from a trip after meeting with a group in his home state. He mentioned to me the secret to the group’s success- Just Do It. Like billions of others, I’ve heard with Nike’s slogan. In the context of shoes, it’s a motivator to do the right thing, to get off the couch and get active. However, for doctor’s, just do it may not be such a good mantra. It is often the easy way out, better for the them, but potentially not for the patient.
As radiologist. other physicians ask for things while caring for patients. They might need anything from a chest X-ray up through a biopsy. When another doctor asks for something, most radiologists learn to just do it. They have learned that their customer, in this case the referring doctor, is always right.
From personal experience I can tell you that to not just do it, but rather to engage in a conversation about the exam’s value may be …less than pleasant. Often the patient sent for the exam is in front of me. I can’t reach their doctor. I have to explain why we might delay the test and go another way. This discussion may take twice as long as the actually completing the exam, the patient’s confidence may be shaken and at times they’re upset. However, I try to think what would I want for my family. As a specialist, I may know more imaging options, the risks and benefits and other options of the “ordered” procedure than the referring provider.
This scenario is not limited to radiology. The medical merry go round of pain has similarities. The patient comes in to see the doctor expecting something to be done. The simplest thing for the doctor is …just do it, write a prescription for narcotics, and get on to the next patient. This starts a sad cascade of care often ending in addiction.
There are personal & financial incentives driving the just do it healthcare cultural. Physicians would tell you they’ve never heard of someone getting sued for getting an imaging study or a biopsy- why should they take the personal risk of not just doing it? And the reimbursement for just “not” doing- isn’t very good. As eloquently illustrated in the Healing of America by TR Reid, healthcare around the world often reflects the countries cultural. We see ourselves as doers. Our incentives via reimbursement, are reflected in our care bias.
Can anything be done to combat the pressure to just do it? I have a simple suggestion- have a plan. Every decision, every test in medicine, should have a next step. Before anything is ordered, there should be a question..what next? As a patient, ask what we (patient and provider as a team) will do next based on the result? If the answer is nothing different, perhaps the first step should be skipped? If you’re not going to have back surgery, regardless of the imaging, perhaps you shouldn’t be image. If you start on narcotics for pain, when are you stopping? What else are is being done to diagnosis and treat the pain. Even when the result is negative, this should be part of a plan. A negative test (eg…there is no evidence of cancer on your CT) can be the most liberating of all- what next? Whenever possible, patients should ask for a plan- tell me the steps we are going to take. Providers should have a plan- how does step 1 influence step 2? And payers should require a plan before reimbursing.
For selling shoes, Just Do It offers encouragement. For care, just do it seems more a cope out than good practice.
