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Patient recourse for (possibly) unnecessary procedures and tests?
Bobble
Registered User regular
Registered User regular
Long story short: I think my mom's doctor dragged out a diagnosis to get more billable shit. Can we do something to get my parents some money back or something?
Maybe this falls under patient advocates, maybe it's lawyer territory, or maybe it's a rare case where the insurance company would actually perk up and give a shit. Or maybe it's fucked altogether. Hoping one of you might help me tell the difference.
Mom's had some knee pain, doctor had her get an x-ray. His reaction to the x-ray was "oh man, I can't really see much in there without an MRI" or something close to that. Took a while to get the MRI, and they drained her knee in the meantime to try to help with the pain. Once he got the MRI, he said it was knee replacement time.
Then of course it takes another week or two to get in to see a specialist, but before the orthopedic surgeon even comes into the room the PA takes one look at the x-ray and says "oh wow, this is pretty bad. You definitely need the replacement."
Naturally, she says "well don't you need the MRI to tell that?"
"No, it's very clear on the x-ray." Then surgeon comes in later and agrees the x-ray was enough to make the call.
Maybe the surgeon's just a scalpel jockey that would recommend surgery for everything, I don't know. I know a radiologist and I'm going to try to get a neutral opinion on the x-ray. If that person says the x-ray should have been enough, do my parents have any recourse about the MRI? Is the patient just screwed in this situation, as if they'd allowed a mechanic to convince them to get an oil change every 1,000 miles?
Maybe this falls under patient advocates, maybe it's lawyer territory, or maybe it's a rare case where the insurance company would actually perk up and give a shit. Or maybe it's fucked altogether. Hoping one of you might help me tell the difference.
Mom's had some knee pain, doctor had her get an x-ray. His reaction to the x-ray was "oh man, I can't really see much in there without an MRI" or something close to that. Took a while to get the MRI, and they drained her knee in the meantime to try to help with the pain. Once he got the MRI, he said it was knee replacement time.
Then of course it takes another week or two to get in to see a specialist, but before the orthopedic surgeon even comes into the room the PA takes one look at the x-ray and says "oh wow, this is pretty bad. You definitely need the replacement."
Naturally, she says "well don't you need the MRI to tell that?"
"No, it's very clear on the x-ray." Then surgeon comes in later and agrees the x-ray was enough to make the call.
Maybe the surgeon's just a scalpel jockey that would recommend surgery for everything, I don't know. I know a radiologist and I'm going to try to get a neutral opinion on the x-ray. If that person says the x-ray should have been enough, do my parents have any recourse about the MRI? Is the patient just screwed in this situation, as if they'd allowed a mechanic to convince them to get an oil change every 1,000 miles?
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I don't think there's much you can do. I don't think it's that odd to get a follow up MRI for joint pain. Maybe the radiologist friend will have an idea.
Yeah, this was all 'in network' with the insurance. Based on some feedback elsewhere I'm looking into a patient advocate. A phone call couldn't hurt.
Presumably your mom went to her general internal medicine doctor. He got an xray of your mom's knee that was full of fluid and then sent for an MRI. Unless it was an orthopedic it's possible the doc isn't seeing that sort of thing that often. However an orthopedic doctor /pa is going to have a lot of exposure to those images so could interpret it better.
As someone who has injured many a joint an MRI is common and can rule out soft tissue issues. It's likely an MRI would have been prescribed by the ortho if not by the original doc.
Yea.. that does sound a little weird, here in Canuckistan almost everytime I had one a Radiologist looks at the images and then let the GP know what they see. The one time that didn't happen was when I dropped a bookshelf on my toes (they were bleeding etc) and the guy who did the stitches was the same guy who looked at the xrays (which clearly showed shattered toes) maybe a radiologist looked at them as well.. I dont know.
I could argue the GP should have just referred them immediately to the ortho but again from the sounds of it the GP didn't feel confident enough in what they were seeing to make a firm diagnosis. In my experience a lot of doctors generally don't like making referrals if they're not confident the referral needs to be made.
And as mts mentioned it's also not terribly surprising a specialist would be able to better interpret an x-ray of a problem that falls under their specialty.
Anyway, I'm gonna look at a patient advocate if they think a lawyer's called for then maybe we'll go down that road, but my expectations are minimal.
Thanks for all the perspectives and feedback! Thread can be closed up.