Responding to Requests for Clinically Inappropriate Blood Tests (e.g. from a Naturopath)
1. Professional, Legal, and Funding Responsibilities — Why You May Decline
| Obligation | Key Principle | Authority |
|---|---|---|
| Good Medical Practice | Investigations must only be ordered when clinically indicated to avoid unnecessary risk/cost. | Medical Board of Australia (MBA) |
| RACGP Position | GPs should request tests only when clinically justified, to reduce harm, MBS misuse, and legal risk. | RACGP |
| Medicare Benefits Schedule (PN.2.1) | The requesting practitioner is accountable for all pathology items billed to Medicare. | Department of Health (DoH) |
| Choosing Wisely Australia | Encourage shared decisions about whether a test is needed, evidence-based, and safe. | Choosing Wisely Australia |
Bottom line: You are not obliged — and may be professionally at risk — if you order tests without valid clinical justification, even if requested by a patient or another practitioner.
2. Clinical and Ethical Risks of Non-Indicated “Screening” Tests (e.g. from CAM Providers)
- 🔸 False positives → patient anxiety, unnecessary follow-ups, overdiagnosis
- 🔸 False reassurance → delay in appropriate diagnosis
- 🔸 Fragmentation of care → undermines continuity and evidence-based practice
- 🔸 Increased audit risk → Medicare scrutiny for unjustified requests
Refer: RACGP and Choosing Wisely guidance
3. Structured Consultation Approach
🔹 Elicit the patient’s perspective (ICE framework)
“What has your naturopath suggested? What are your thoughts and concerns about your health?”
🔹 Assess for clinical indication
- Perform history and examination.
- Apply RACGP guidelines and evidence-based criteria.
🔹 Educate and negotiate
- Explain why some tests may be unhelpful or harmful.
- Use the Choosing Wisely “5 Questions” as a patient-friendly tool.
🔹 Offer appropriate alternatives
- Symptom monitoring
- Lifestyle interventions
- Evidence-supported investigations
- Invite the CAM practitioner to submit a clinical rationale or summary if available
🔹 Shared decision-making
- If tests are still requested:
- Offer as private (non-Medicare) request if low risk and patient consents
- Or respectfully decline and suggest a second medical opinion
🔹 Document thoroughly
- Patient request, clinical rationale, risks discussed, decision made, and plan
🔹 Preserve rapport
Emphasise your duty of care, not a refusal of care:
“I want to ensure you receive the right tests at the right time — ones that truly support your health.”
4. Suggested Wording with the Patient
“I understand these tests were recommended by your naturopath. After reviewing your history and performing an exam, I don’t see a medical reason to order them at this stage. Unnecessary tests can sometimes be misleading or lead to more harm than benefit. The safest approach is to monitor your symptoms and reassess in [timeframe]. If you prefer a second opinion, I’d be happy to help arrange that.”
5. Optional Reply to the Naturopath
Dear [Name],
Thank you for your involvement in our shared patient’s care. I have reviewed the requested pathology and, at this time, there is no clinical indication to proceed based on current RACGP and Choosing Wisely guidelines. Additionally, Medicare requires that all tests be clinically justified. I will continue to monitor [Patient’s Name] and arrange appropriate investigations as needed. Please feel free to forward any clinical information that may change this assessment.
Kind regards,
Dr [Your Name]
6. Practical Take-Home Checklist for GPs
✅ Check MBS/RACGP guidelines before ordering tests
✅ Use plain language to educate and reassure the patient
✅ Decline tests respectfully if not clinically indicated
✅ Offer alternatives and document your rationale
✅ Discuss recurring requests with your team for consistent handling
7. Recommended Resources
- RACGP Position Statement: Responding to patient requests for non-indicated tests
- Choosing Wisely Australia: “5 Questions to Ask Your Doctor” (handout)
- MBA Good Medical Practice: Sections 3.13–3.16 – Investigations & Referrals