How to understand that you are being promoted for unnecessary spending in a paid clinic

Too many tests are being ordered

If you came to the doctor with a common runny nose, and left the office with a bunch of referrals for expensive tests and examinations, you should be on your guard.

Often, a detailed blood test is sufficient for the initial examination.

And yet you do not need a hormone test, MRI or ultrasound.

Check with your doctor for what to take this or that test. Making them "just in case" and paying tens of thousands of rubles is definitely not worth it. Feel free to ask questions. Clarify what is the rationale for a specific appointment. The doctor should explain in detail and clearly why he recommends doing an analysis or taking a certain medication.

If you do not trust your doctor, go to see another specialist with a good reputation and see what tests he prescribes. And only then draw conclusions.

Rush you

"The problem is easily fixable, the operation can be organized tomorrow", "You are lucky, you can go through the magic procedure right now with a decent discount", "If you undergo a comprehensive examination, it will be much cheaper" …

Typically, the purpose of these “great deals” is to get you to say “yes”. Unless, of course, we are not talking about a life-threatening condition and urgent hospitalization.

Take your time to give a positive answer. Take a break. If the clinic staff in response to this begins to scare you that you will "miss a good chance", with a high degree of probability you will be bred for unnecessary expenses.

You are persistently recommended something

A procedure or examination that can be done “exclusively in our clinic” is a reason to think and be wary. It's one thing when an institution specializes in the treatment of certain diseases. But most private clinics have a wide profile, and therefore the uniqueness is most likely greatly exaggerated.

Before agreeing to treatment, research the market and prices in other clinics. Find out how much an examination in independent laboratories costs.

Also, do not give in to the offer to purchase supplements, vitamins, phytopreparations at the "super price". The main rule is to look for an alternative, compare, read reviews.

What should be alarming

You take a long time to heal, but your recovery is very slow.
At each subsequent visit, the doctor finds new sores in you and prescribes additional examinations.
The clinic cannot clearly explain why you were prescribed this or that examination and procedures.
After you turn down the "super-advantageous offer," the attitude changes dramatically, becomes colder.

What do the doctors themselves say

If a patient turns to a commercial organization, he will inevitably be promoted for money. He has no chance, he is defenseless. Everything will be reduced solely to the appetites of the clinic, the average check of marketers and the make of the car that the owner of this private center wants to drive.

Slightly better is the situation in dentistry, where a significant part of clinics operate within the framework of market mechanisms, and therefore they must be competitive.

Dmitry Malykh Practicing pediatrician, neurologist

Unfortunately, there is no reliable way to reliably understand that a medical institution will carry out the required amount of research and manipulation based on your health status.

But there are some tips to help you avoid a huge bill for unnecessary services and get quality medical care:

Collect information about clinics. Make a choice in favor of a medical institution where doctors work on the principle of evidence-based medicine. This will give a chance to protect yourself from unnecessary expensive examinations. Everything will be done solely according to indications, based on the recommendations of the guidelines of reputable international medical associations.
Prepare for your appointment. Write in advance a list of questions that you will address to your doctor. From my point of view, the doctor should clarify any, even insignificant nuances. This will help save money on repeat consultations.
At a basic level, try to figure out on your own the problem with which you go to the doctor. The key factor here is the choice of information sources. I strongly advise against using Google keyword searches. This will only confuse.

As a trusted and authoritative source for patients, I recommend:

The section for patients of the world's most authoritative medical reference Uptodate.
Mayo Clinic Patient Section.
One of the best Russian medical sites "Evidence-Based Medicine for All".

Alexey Paramonov Candidate of Medical Sciences, Head of the Center for Expert Gastroenterology at the Rassvet Clinic (Moscow)

There are two main reasons for unnecessary examinations: the doctor's mistake and his malicious intent (or not very evil - a conflict of interest).

Somehow I happened to see the system of motivating doctors of one of the largest private clinics in the country. They received 10% of the cost of the prescribed colonoscopy or gastroscopy. This in no way means that the doctor will automatically order unnecessary examinations.

But the employer seduces him with this opportunity. We are all human, the ability to resist temptation is different for everyone.

A real story that happened to my patient in one of the Moscow business segment clinics. He came to see a gastroenterologist, but the administrator handed him a hefty pack of directions for tests. The patient stated that he would prefer to have the tests ordered by the doctor.

However, at the appointment, the gastroenterologist immediately asked: "Where are the tests?"

- Maybe you will appoint them? the patient asked timidly.

- Didn't the administrator give you directions? - the doctor answered with amazement and indignation.

- I did, but …

- Show me … But right there and half of the necessary tests are not! - summed up the gastroenterologist. At the same time, he did not even know what the patient was complaining about.

Why it happens? There are several systems for motivating doctors. The simplest one is that the doctor receives a percentage of all appointments. More difficult - he receives a salary, but he has a percentage of highly profitable complex methods.

Otherwise, the doctor does not receive a percentage, but earns bonuses for meeting the standard. The problem is that self-written standards are used. At best, the standards of the Ministry of Health are taken as a basis, which are developed for completely different purposes. The result is one: the patient receives three times more prescriptions than necessary.

These systems operate in most medical organizations, including those in the top 20 in terms of revenue. In the Moscow market, I know of only three chains where such a conflict of interest is not deliberately created by management.

There is no universal, reliable way to recognize that you are being prescribed unnecessary. But there are some nuances.

A highly qualified and self-respecting doctor who knows international treatment standards and follows them, deviates from them with great difficulty and under serious pressure. Working according to international protocols is a component of evidence-based medicine. Such a doctor can always justify his prescriptions, referring to the clinical manual or guideline.

Such doctors, as a rule, willingly discuss with the patient the indications for a particular examination, they say how the further treatment tactics will change, depending on the results. If it does not change, this is a sign of unnecessary testing.

There are several ways to define an evidence-based medicine doctor:

He does not diagnose vegetative-vascular dystonia, biliary dyskinesia, chronic pancreatitis with exocrine insufficiency, dysbiosis, osteochondrosis of the spine, discirculatory encephalopathy, increased intracranial pressure. He will definitely not find these chronic viral infections in you: herpes, cytomegalovirus, Epstein-Barr virus, multi-month chlamydia.
He does not prescribe rheoencephalography, study of Foley points, echoencephalography, any physiotherapy on devices (electrophoresis, amplipulse, laser irradiation), plasmapheresis (with rare exceptions in very serious patients in the hospital), laser or ultraviolet blood irradiation, courses of vascular and vitamin droppers. Does not prescribe the drug in injections if there is an analogue in tablets.
Immunostimulants (Derinat, Anaferon), vascular drugs (Stugeron, Cinnarizin, Vinpocetin, Cavinton, Sermion, Fezam, Piracetam), "Nootropil", "Actovegin", "Cerebrolysin"), antiviral against ARVI ("Kagocel", "Arbidol", "Anaferon", "Amiksin", "Otsillococcinum", "Ingavirin"). A manifestation of epic ignorance is the appointment of systemic enzyme therapy ("Wobenzym", "Phlogenzym").
He cannot be a homeopath, anti-vaccine, HIV-dissident, deny the role of statins and anticoagulants in prolonging the life of cardiac patients. He cannot prescribe drugs for cholesterol or for blood pressure in courses: "Have a drink, and then a break, let the liver rest." He also will not prescribe hepatoprotectors, since there is simply no such group of drugs in developed countries.

In this way, you can distinguish a competent doctor from an illiterate one. What is important: it so happened that a competent doctor is also usually honest.