First published on October 21, 2011, I think reading this again is necessary!

In “Doc, Do I Need That Test?” (http://livewellthy.org/2011/02/10/doc-do-i-need-that-test.aspx), I attempted to define what is “necessary” from a medical point of view.  Necessary is one of those ambiguous words, defined differently by patients, their spouses, docs, insurers, and Medicare.

When I began practicing medicine 30 years ago, my patients trusted me to know what was necessary.  As I matured as a doctor, I began trusting my patients and included them in the process of deciding the necessity of any given treatment, procedure, or medication.  In recent years, my patients and I have lost our right to define necessity to a clerk who answers an 800 number and follows a computerized protocol as well as to the news media.

The problem is that I always know what was necessary after the fact.  The magic “retrospectascope” is an all knowing tool.  If only we had one.  Since we don’t, the best my patient and I can do is to look at all sides of an issue and go with our best judgment.

What defines “Unnecessary” care has become a great point of contention in society and in every day practice.  Dr. Darrel White’s article on KevinMD looks at the necessary/unnecessary debate through his lens, http://www.kevinmd.com/blog/2011/10/unnecessary-care.html.  It is well worth reading.  Hopefully, your vision is good enough to enjoy it!

I think I just saw a white Crown Vic drive by.  I better go out and check on my dogs.  If you don’t understand this comment, read the article.