When patients request diagnostic tests that fall outside established guidelines, clinicians face a tough challenge: balancing patient reassurance with evidence‑based care.
Ordering non‑indicated diagnostic tests isn’t always straightforward, especially when requests are driven by anxiety, misinformation, or past experiences. Some patients fear hidden disease, others come armed with online research, and many simply want “peace of mind.”
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Key takeaways about ordering non-indicated diagnostic tests:
Family Practice
"For those patients who are adamant to request diagnostic testing that isn't indicated, I first give them the most updated guidelines from either the CDC or AAFP, then I ask questions as to the why behind their concern. I feel it is important to allay any fears and misconceptions, and that will be enough to not order the tests. For the select few patients who need to have them, I will order them to help ease their fear and anxiety if necessary."
Family Practice
"If the diagnostic test is not within the guidelines, but is sensible and known to me as a directive that may aid in establishing the diagnosis, I am often agreeable to it. If I firmly believe that a test is not only not within the guidelines of a possible suspected diagnosis, but one I'm not familiar with and/or may yield nebulous results, I defer. We have a saying in medicine, 'never order a test unless you're prepared to act on it.'"
Internal Medicine
"A lot depends on their reasoning, and I will hear them out and discuss. Generally, I will be open to giving someone peace of mind if testing is safe and we agree in advance how to follow up. Always caution that overdiagnosis or finding unnecessary problems can arise."
Cardiology
"I would be respectful and explain the clinical guidelines at length. I would discuss how one test is not necessary and discuss other options."
Hospitalist
"I explain downstream procedures following diagnostic testing and risks of false findings when non-indicated testing occurs. Utilize decision aids/decision tools when possible. I would refer to an alternative provider if inconsistent with the continued care paradigm."
Family Practice
"This one is a problem. It is good to reassure a patient when they have become consumed by a diagnosis that they fear. I try to explain the guidelines and how we use them. I also explain to them the financial implications. And, I also explain to them the unintended consequences of pursuing incidental findings. After all that, I usually let them have their way about it after a thorough discussion."
Surgeon
"I don't assume that patients know what the guidelines are, so I educate them and go through what the guidelines say and explain why the tests they are asking for are not indicated. Now with the world becoming so litigious, and depending on what tests they are asking for (if it's something easy like blood work), I can offer ordering the tests, but they would have to pay out of pocket, as there's no actual indication for ordering the tests."
Family Practice
"Education on insurance coverage, risk, including radiation exposure, information that can be gathered from the diagnostic test, and whether it will address the patient's concerns. I am not against ordering tests that are indicated by guidelines as long as the patient is in the know."
Oncology/Hematology
"I explain that new tests require time for development or clinical protocols to respond to results. In oncology, the classic question is the use of CtDNA. While it’s easy to order and the company doesn’t charge patients if insurance rejects it, the information is difficult to incorporate into clinical practice for changing care due to the lead time bias of results. Just have to have an honest conversation, and patients usually understand the blind spots in testing.
Of course, some patients have an outside HCP in their ear, and they’ll get the test regardless. We sometimes provide a disservice to our peers by counseling our friends and family in this regard to go against the advice of their treatment team."
Family Practice
"If a patient wants a test, I will usually order it unless it is outrageous. I have been humbled by finding diagnoses that I did not expect, which were found by labs over time. I always discuss the cost and non-covered status of these, and they have to understand it's likely out of pocket to them."
What approach would you recommend when a patient asks for an unnecessary diagnostic test? Share your perspective and read all of the comments on the post on Healthcasts.