The Challenge of Getting Timely Diagnoses: Doctors' Hesitancy to Prescribe Diagnostic Tests

Delayed Diagnoses and Treatment

Getting a timely diagnosis is crucial for effective treatment, but many individuals face challenges due to doctors' hesitancy to prescribe diagnostic tests. This reluctance can lead to delayed diagnoses and treatment, causing frustration and potential harm to patients.

One individual's experience sheds light on the difficulties faced when seeking a timely diagnosis. Despite suspicions starting at the age of 16, it took until the age of 28 for them to be diagnosed with Polycystic O**** Syndrome (PCOS). This delay can be attributed to doctors dismissing symptoms as stress-related and advising the patient to avoid stress, further prolonging the proper diagnosis.

In some cases, patients take matters into their own hands and resort to self-initiated blood tests to monitor their conditions. For instance, individuals with PCOS may measure their prolactin levels to gain insights into their hormonal imbalances. While this approach provides some information, it cannot replace a comprehensive diagnostic test conducted by a medical professional.

Even new doctors may exhibit hesitancy when it comes to prescribing additional tests, such as MRI or CT scans, to confirm a diagnosis. Patients have shared similar experiences, with some even resorting to dressing up in professional attire in hopes of being taken more seriously by their healthcare providers.

It's important to note that this trend is not limited to a specific gender demographic. Both men and women have encountered reluctance from doctors when it comes to ordering diagnostic tests. This highlights the need for a systemic change in the medical community's approach to diagnosing and treating patients.

Veterans have also faced difficulties in obtaining necessary tests. In some cases, individuals have had to travel to other countries, such as Mexico, to undergo MRIs due to barriers within the healthcare system. This highlights the need for improved accessibility and availability of diagnostic tests for all individuals, regardless of their background or circumstances.

The reasons behind doctors' hesitancy to prescribe tests can vary. Concerns about unnecessary surgeries or prescriptions that could potentially harm patients may influence their decision-making process. In countries with publicly covered healthcare, doctors may also be encouraged to avoid running unnecessary tests to conserve resources and prioritize patients who are strong candidates for those tests.

The "when you hear hooves, you think horses not zebras" approach is often taken by doctors. This means that they start with the most common problems and solutions before considering rarer cases. While this approach can be efficient in many instances, it can also lead to delayed diagnoses for individuals with less common conditions.

Cost can also be a factor in doctors' decisions to order tests. Expensive tests like MRIs may not be routinely used to confirm a diagnosis of PCOS, as ultrasound imaging provides the most detailed information for counting follicles in the ovaries.

Doctors generally only order tests if the outcome will result in a specific action or treatment. If the deviation from normal levels does not require immediate treatment or pose a risk of causing harm, doctors may be hesitant to order blood tests. The decision to order tests weighs the potential benefits against the risks, even for noninvasive tests.

Evidence-based medicine plays a significant role in doctors' decisions. Comprehensive studies that assess different diagnostic tests help determine the best approach for patients with similar conditions. Patients can reference evidence-based guidelines, such as the ACOG 2023 International Guideline for the Assessment and Management of PCOS, to discuss alternative approaches with their doctors and advocate for appropriate testing.

In the United States, insurance companies often dictate what tests doctors can order. They require a well-defined medical reason and a specific diagnosis for the test to be approved. This adds an additional layer of complexity and limitation to the diagnostic process.

Doctors' hesitancy to prescribe diagnostic tests can result in delayed diagnoses and treatment for patients. Factors such as concerns about unnecessary procedures, resource allocation, cost, and reliance on evidence-based medicine all contribute to this hesitancy. It is crucial for patients to advocate for themselves, reference evidence-based guidelines, and engage in open discussions with their healthcare providers to ensure timely and accurate diagnoses.