Title : The million-dollar workup
Abstract:
Doctors work in a paradigm of defensive medicine, defined as “the practice of recommending a diagnostic test or medical treatment that is not necessarily the best option for the patient, but mainly serves to protect the physician against the patient as potential plantiff” (Wikipedia: Defensive Medicine, 2025). It's a reflex against a core vulnerability of the practice of medicine: we take care of people and sometimes it goes wrong. Except, this reflex is not always in the best interest of the patient.
In the million-dollar work up I describe below, the repetition – repeat procedures, repeat laboratory tests ordered three-times over – highlights a second vulnerability that cannot be taught, only experienced: as doctors, we face diagnoses that will break your heart.
The disease in question has a highly variable – and often initially vague – presentation. My patient had all the appropriate work-up in a relatively timely manner. And it didn’t matter. She was misdiagnosed; she was given the run around; and (debatably) healthcare resources were overutilized.
This presentation explores what happens when medicine is confronted with a devastating diagnosis – when the effects of moral hazard are at odds with the human desire for certainty.
