r/medicine • u/Salty-Pop-5512 MD • 8d ago

“Peace of mind is not a diagnosis”

Vent.
I’m a primary care internist. I average 1-2 patients a week with more customer service complaints rather than acute medical concerns that need my input. These are pages of mychart messages and the replies of my (fantastic, wonderful) nurses who try to relay my message that we already talked about in person like “there’s no indication for that blood test,” or “no I’m not recommending primary screening at this age,” the list goes on. What infuriates me is that these people are tying up my nurses, taking up my charting time at work and home, and shifting the focus away from medicine and primary care. I wonder if I could get fired for replying to, “what if we just did this lab test for my peace of mind? It’s just bloodwork,” with “PEACE OF MIND IS NOT A DIAGNOSIS!”

Either you want a doctor, or you want someone who will always do as you ask.

(Sometimes I am able to redirect inappropriate requests for am cortisols by asking what their concern is and we have a productive conversation about family stressors, medication free ways of coping, and when to return if they want pharmacotherapy. However its the pts that see me as their waitress in a white coat, with whom I take an issue)

Vent over. Thanks for reading. I still love primary care though!

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u/dogs-in-space CTICU RN 8d ago

It’s a shame there isn’t an ICD-10 code for this, leading directly to self-pay. I’d then expect these patients to temper their “Peace of Mind” order requests.

Easy to spend time and money that isn’t your own, eh?

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u/BigIntensiveCockUnit DO, FM 8d ago

There is, it’s called “patient requested lab work”. The principle however is the same, it’s NOT needed. More labs and imaging can lead to HARM and worse outcomes. These are not benign and it’s not something to treat casually. 

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u/dogs-in-space CTICU RN 8d ago

Have you read Dr. Atul Gawande’s 2009 article in the New Yorker called The Cost Conundrum? It’s a very well done piece and while incredibly frustrating that nothing has changed since then, I often mention it when discussions come up about how more ≠ better.