How should I respond when a patient asks me to order lab tests their naturopath wants?

Empathy and explanationI discuss it with them and take a good history and physical, if relevant. I explain to them, after our discussion and exam, if it is likely that we will need certain tests. If we do, I will order what is medically necessary and explain why. If there is a test that is being requested that is not necessary or unwarranted, I will explain that 1) this test is not diagnostic/helpful for their concerns, so taking their blood for this purpose is futile; 2) it is a waste of healthcare resources; 3) since I am the ordering provider, I am responsible for the tests that I order and following up on them—if it is not indicated or useful, it would be unprofessional and irresponsible for me to order them. Often, this is enough to remedy the issue and satisfy the patient. Taking the time to communicate clearly and empathetically is important. A blunt “no” from the get-go, or downplaying the role of other healthcare providers, will never ease this situation. We cannot make everyone happy. But we can practice empathetic, evidence-based care that is still patient-centred. Risks and false positivesI would tell the patient that I practice allopathic evidence-based medicine and that I will order investigations that align with what I am licensed to do. I would also explain that I am responsible for any test that I order, which means reviewing the results and acting on anything that might be abnormal. I then explain that any test can produce false-positive results and that those false results then lead to more interventions and risk next steps. My “closer” in almost all cases is that I wouldn’t want the test in their circumstances if I were them or if they were a close family member.Chart request chargeI will usually review the requested tests and order only the ones I consider medically indicated. I also discuss that naturopaths are not OHIP-covered and that some of the tests requested are therefore not covered. More often requested is the last set of bloodwork for a patient, which I will fax to them. But when there is a request for chart documentation and multiple pages of information, we do charge the chart transfer fee to the patient.Make an appointmentIf they are tests I would order, I send in a requisition. Sometimes there are requests for blood work I have never ordered in my 40 years of work. I refuse to order those tests, but we do explain to the patient why a test is not appropriate. My colleagues at our local walk-in won’t order them either. If the patient gives us any grief, we offer an appointment to discuss the concerns that prompted the visit to the naturopath in the first place. Patients have been generally receptive to this approach.

How should I respond when a patient asks me to order lab tests their naturopath wants?

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