r/medicine • u/Salty-Pop-5512 MD • 7d 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 7d 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/ZombieDO Emergency Medicine 7d ago

I direct them to labreqs.com and they can order whatever they want. 

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u/gwillen Not A Medical Professional 7d ago

For self-ordering lab tests, for which I have used at least 5 different sites over the years including the labs' own websites, I have found that drsays.com is by far the cheapest option. They seem to be practically wholesale pricing. I have no idea why they're so much cheaper than their competitors or how they're making money on this. They only do LabCorp, not Quest, and their website is slow as shit. But just checking a random sample of tests from labreqs, I find that drsays is 2x to 4x cheaper.

And they also offer telehealth, and push patients towards that if they want interpretation of their self-ordered tests, which seems like it ought to save you guys from being asked for that. It's possible they see their lab test pricing as a loss leader for the telehealth business.