A major impediment: Patient expectations

Dr. Gabriel Ledger's note on patient expectations:
A major impediment to minimizing patient testing is patient expectation. My patient with a viral chest cold expects a chest X-ray, to prove that his two-week cough isn’t pneumonia (it isn't), and the mother of my three-year-old patient who tumbled off the sofa expects a CT scan, to prove that everything will be fine with the child’s brain (it will be fine, except for the unknown long-term results of the radiation from the CT scan). When the tests aren't done, the patients leave my E.R. dissatisfied and write complaint letters to the hospital. And, in the rare instance that the viral chest cold later turns into pneumonia, the patient assumes that I "missed it" and wants to sue me. Doctors need to be held accountable for over-testing, but let's not forget how patient expectation affects the issue.

Thanks for Dr. Ledger's letter, reprinted from the June 29 issue of the New Yorker.