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The Consult Guys - The Asymptomatic Carotid Bruit: Not Such a Pain in the Neck After All?The Asymptomatic Carotid Bruit: Not Such a Pain in the Neck After All? FREE

Geno J. Merli, MD; and Howard H. Weitz, MD
[+] Article, Author, and Disclosure Information

Disclosures: Geno J. Merli, MD, reports the following: Research grants/contracts: Bristol-Myers Squibb, Bayer, sanofi-aventis; Consultancies: Bristol-Myers Squibb, Bayer, sanofi-aventis. Howard H. Weitz, MD, reports that he has no financial relationships or interests to disclose.

Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that she has no financial relationships or interests to disclose. Darren B. Taichman, MD, PhD, Executive Deputy Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Pfizer.


Ann Intern Med. 2015;162(8):CG1. doi:10.7326/G15-3004
© 2015 American College of Physicians
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The Consult Guys - The Asymptomatic Carotid Bruit: Not Such a Pain In the Neck After All?

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The angry patient
Posted on May 4, 2015
Mark G. Bamberger, MD
Attending Physician, Cedars-Sinai Medical Center, Los Angeles, CA
Conflict of Interest: None Declared
Excellent discussion. This is not my patient so I don't know how he or she would feel after the discussion, if in fact there was one. Your explanation and appropriate "defense" of not screening is great for the clinician. Unfortunately, I have found explanations along these lines difficult for some people to understand. Patients often get some part of it, but then don't believe that the recommendations apply to them. Sometimes we end up battling our colleagues. Some patients believe that the "better" physicians are the ones who do more tests. In a fee-for-service environment, there is incentive to "be better." Telling a patient that another physician is incorrect, or not in keeping with the current data is difficult. Again, I enjoyed your discussion. I am just pointing out that patients often don't understand. No matter what the literature supports, many will still line up for the low-cost mobile screening tests that you mention. They'll still push for stress tests and often question their physician's commitment if those, and tests like them, are not ordered. Saying no to tests is still challenging.
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