Folk diagnostics of diseases – Newspaper Kommersant No. 162 (7363) dated 09/05/2022

Experts of the Action Medicine service asked doctors about how often they encounter requests from patients to prescribe additional examinations and how they relate to the active position of citizens. It turned out that more than half of the respondents receive such requests in 20-40% of cases and more often. At the same time, 84.3% believe that examinations initiated by patients are redundant. Most often, patients ask for CT and MRI, as well as ultrasound of the whole body and tests for “all hormones”. Doctors interviewed by Kommersant explain such statistics by the imperfection of the healthcare system and warn that unnecessary manipulations can harm health.

Experts of Action Medicine (an expert support service for specialists from medical organizations; part of the Action group), together with the Doctors of the Russian Federation community, conducted a survey of medical workers about additional examinations initiated by patients. 1154 doctors took part in the study, 71.2% of them work in state medical organizations, 14.4% in private clinics and the same number are part-timers.

23% of the interviewed specialists answered that every second of their patients requires additional examination. Another almost 40% of respondents encounter this less often: from 20% to 40% of patients ask for “extra” tests. And only 6% of doctors said that patients completely trust them and therefore do not ask for new studies.

At the same time, most specialists (84.3%) believe that examinations initiated by patients are redundant. It is interesting that doctors in private clinics, in comparison with state clinics, more often consider such requests to be justified (9.8% versus 3.5%).

The scientific director of the network of immunorehabilitation and preventive medicine clinics Grand Clinic, Olga Shuppo, confirms that many commercial clinics and laboratories prescribe unreasonable examinations and analyzes on the “everything in a row” principle so that the patient pays as much as possible. In public clinics, on the contrary, they carry out too few tests: “The range of studies is narrowed, which makes it difficult to make a diagnosis and does not allow the doctor to get complete information about the patient’s condition.” At the same time, Ms. Schuppo argues, doctors of preventive medicine, about the need for the development of which the authorities are now talking so much, should prescribe more “targeted” modern check-ups, with fewer tests, but “correct” ones, which open up a complete picture for the doctor.

According to doctors, most often patients ask for additional computed tomography or magnetic resonance imaging (so answered by 61.44% of respondents), take standard tests – blood, urine (16.38%), do a study on tumor markers (8.06 %) and ultrasound (6.24%). Some physicians noted that sometimes patients demand “whole body ultrasounds”, “whole body scans” and “full body examinations”, as well as tests for “every hormone that exists in nature”.

Patients, according to doctors, decide that these additional examinations should be ordered based on the search for symptoms on Google, Yandex or on patient sites (69.9%), and because they are simply hypochondriacs (19.4%) . Among other reasons, respondents named: recommendations from friends, acquaintances, patients, doctors from private clinics (5%); reading domestic clinical guidelines (2.3%).

At the same time, just the reference to clinical recommendations becomes the reason for 76% of the surveyed doctors to prescribe the examination that the patient asks for. About 10% of specialists never refuse citizens if it is “more calm” for them, and 6%, on the contrary, always refuse, because they believe that excessive examinations are harmful to health.

“It is precisely because of attempts to make a diagnosis on their own that doctors are wary of such requests, although sometimes, against the background of a long diagnostic search, when a patient cannot be diagnosed for years, independently found studies can be really necessary,” the leading expert of Action Medicine comments on the survey. Natalya Zhuravleva. According to her, Russian doctors, who have not yet completely abandoned the paternalistic model of communication with patients (when the chief doctor himself determines the tactics of diagnosis and treatment without consulting the patient), treat such initiative with disdain: “In their opinion, the patient is not having a medical education, he himself cannot make a correct assumption regarding the causes of his condition, and therefore, correctly determine the list of necessary examinations.

Ekaterina Kuzina, medical director of MK Doctor Nearby, confirms that the company’s doctors daily encounter patients who ask for either a specific examination or a specific list. The justification for requests can be completely different, but in most cases this is a requirement that cannot be disputed, according to patients. This conviction is based on several premises. The leaders among them are the following – searching for information from the Internet, patients “google” the symptoms and make decisions based on them, consult with friends, relatives and neighbors, strive to thoroughly understand every process that takes place in the body, ”says Ms. Kuzina. She warns that the passage of “all possible medical research” can lead to undesirable consequences.

The co-chair of the All-Russian Union of Patients, neurologist Yan Vlasov also sees the problem not in the relationship between the patient and the doctor, but in the lack of balance in the healthcare system. He refers to the opinion of the Association of Laboratory Professionals and Organizations that half of all examinations are done for other purposes, that is, they do not make sense. In addition, Mr. Vlasov continues, it is beneficial for the hospital to motivate doctors to prescribe additional examinations – it forms its fund from income from services that are not necessary for the patient.

“It is necessary to raise the level of laboratory diagnostics, the quality of consumables so that they suit all healthcare participants. Calculate the completed case of medical treatment and make an adequate tariff for compulsory medical insurance, ”concludes Mr. Vlasov.

Natalya Kostarnova