What do you do when your doctor offers you a "menu of services" to choose from?

some tests are not mandatory, but many patients request them. it IS his job to tell you what those tests are for, how they are performed, what the risks of the test are, and what the risks of NOT taking the test are.

in this day of informed consent and giving patient as many choices, it’s HIS job to tell you all your options and YOUR job to make an informed decision about what tests you want/need. you should ask him to explain in detail what the various tests do etc. i usually just get the normal “check the status of your eyes and eye #” test and skip all the fun extra tests that insurance usually doesn’t cover. but i am sure he will tell you how many people die/year of glaucoma etc. so depending on your AGE, health condition of your eyes etc, you should decide what you need to get done and what you can afford.

It sounds a bit like a rip off. Like the others say its your health care professionals job is to decide on the tests you need and explain why. Just giving you a list and asking you what you want is useless as you might not ask for important tests and waste your money and his time on stuff you don’t need.

@lightlyseared – the doctor would tell the patient to do a test if it was very important and crucial to their health. and even though some people might not like having to make these decisions, the medicine field has changed to this because of the countless malpractice lawsuits etc. some people like to be more in charge of what they get/pay for, otherwise they shout and scream that the doctor is making them do “unnecessary tests” and are basically trying to steal their money. and so we see the transition from paternal medicine to a more patient autonomy kind of medicine. whether this is good or bad depends on each person’s point of view of course.

Whether we agree with your doc or not, it sounds like you may not fully trust your doc. So, it may be time to find another doctor.

There are some professions that you lean on a strong and confident course of action – doctors, mechanics, real estate agents, etc. If you don’t feel as if you are getting a clear recommendation or a recco you trust, its not wrong to find someone who’s style you mesh best with.

Yes it is important to be involved in decisions regarding your care. But being handed a list of tests and asked which you would like is of no help to any one and is leaving the Doctor open to malpractice lawsuits.

Glaucoma test – if you are over 40, have diabetes, a family history of glaucoma or are short sighted you should have the test. Glaucoma causes blindness and by the time you notice changes in your vision its too late. In the UK whenever I have had an eye test they do this without asking. Visual field testing can also detect changes caused by glaucoma but may also be recomended if you are taking certain medications or there was some concern about your peripheral vision.

The point is there are loads of tests doctors can do but they will only know if they are relevant to you and will provide meaningful results if they talk to the the patient (getting back to the malpractice thing, the main complaint against health care professionals is poor communication) being given a menu of stuff and asked to choose what you want with out being examined or told why they recomend the test is really quite poor.

@lightlyseared – i agree completely.

Let me reflect on why this happens from firsthand experience. Years ago, doctors were able to treat patients without any questions or feedback from patients (and much less malpractice). Then, around the 1960s-1970s, a new movement arose favoring patient autonomy (i.e. the right of the patient to make their own medical decisions) and rejecting medical paternalism. Thus, some physicians have adopted a model where they present a list of options, and let the patient choose. This allows a certain freedom from liability, since the doctor can say “she chose this option, its not my fault it didn’t quite work out.”

In my opinion, the movement towards full patient autonomy is a failure. Patients are never educated or objective enough to make difficult decisions for themselves (not that choosing a few eye exam options is “difficult”, but I digress). I think the best model is one of education and direction. Such as, “Ms. Smith, you have options A, B, and C. I recommend option A, for the following reasons….” Or, frankly, if one option is truly better than the others, then no options should be presented, to prevent undue confusion. To leave difficult decisions up to the patient and their family is misguided and a failure of the medical system.

I would add that an optometrist is not a doctor, and thus is not bound by the same conflicts. This particular scenario smacks of profiteering.

Is this one of those store front eye doctors? It sounds more like a fast food joint! It’s good to know what things cost, but a good doctor should tell you what you need and when. if this is a doctor you have been seeing and you trust him, ask him to tell you what tests you need, why and when.