I’m not exonerating the medical profession here, either. There is also the self-serving motive to order more tests because of potential liability (thank you, legal profession). Doc’s sort of between the proverbial rock and a hard place. He wants to do a more thorough work up for that patient’s benefit, and his own security, but financial and time constraints won’t let him. Personally, when all is said and done, I, and pretty much all the docs that I know, opt for the history and physical exam to arrive at a initial working diagnosis. The more complete the history and more thorough the physical exam, the more accurate that initial working diagnosis (that’s where your “skin cancer screening test would be included). Completeness and thoroughness take time, but a benefit of spending more time with the patient is that you get to know him/her better, and as such you can treat him/her better. The down-side of that is you make less money, so your practice has to be smaller and slower (and you make less money). Oh, and any tests ordered after arriving at an initial diagnosis should be directed at confirming the diagnosis and as such I should have a pretty good idea what the test results will be before I order the test. If the tests don’t confirm the diagnosis, I will re-interview/re-examine the patient and modify the diagnosis accordingly. If things still don’t add up, I will likely consult with a specialist in the area of concern. I explain my thinking to the patient as I go along. Obviously this takes time to talk, but the patient and I get to know each other better, with regards to their care. Not much money in this approach, I’ll admit. BTW, I don’t do insurance of any kind. Cash only. Initial and basic visit costs a fixed amount. Extra time=extra charge, etc. Oh, and I don’t carry malpractice insurance. (Much cheaper that way besides, I don’t have much of anything lawyers would want.)
Sounds like a very good approach.