Responding to patient requests for tests not considered clinically appropriate


Page last updated 17 April 2025

1. Position

To prevent harm to patients, meet professional obligations, reduce medico-legal risk, and ensure appropriate use of the Medicare Benefits Schedule (MBS), GPs should only request medical imaging and pathology tests that are clinically indicated.


2. Key Points

When receiving requests from patients for specific medical imaging or pathology tests, GPs can use various strategies for dealing with requests and can adapt their response to suit individual patients.

GPs are advised to:

  • offer to assess the patient’s presenting concern and determine whether there is a need for particular tests
  • explore the reasons for the patient’s request
  • decline requests for tests that are not clinically relevant
  • explain their reasoning for denying test requests in a sensitive manner, encouraging shared decision making
  • bear in mind that patients may have sought answers from complementary and alternative approaches after not benefiting from conventional medical assessment and treatment.

Patient-centred communication skills are necessary for building mutual understanding and trust to maintain long term relationships with patients.1  


3. Background

Medicare benefits are available for eligible pathology and diagnostic imaging services where the treating practitioner decides the service is clinically relevant and is eligible to request these services for the purposes of Medicare.2 A clinically relevant service is one which is generally accepted by the profession as necessary for the appropriate treatment of the patient.3

GPs occasionally receive requests from patients to request specific medical imaging or pathology tests that may not be appropriate in the management of the patient. Test requests arise from a variety of sources.

Complementary and alternative medicine (CAM) practitioners are unable (in most circumstances) to request pathology and diagnostic imaging under the Medicare system. Sometimes, patients are advised they can avoid paying for specific tests if they ask a GP to request them through Medicare. Requests also occur when patients research their symptoms and present at the clinic with a proposed course of action.4 Patients may also request annual pathology testing as a preventative activity, which may not be required. For further information on recommended preventive tests and activities, refer to the RACGP guidelines for preventative activities in general practice (Red Book 10th edition).

GPs may experience pressure to comply with these requests in order to preserve good relationships with their patients. However, there are various risks associated with requesting tests that are unlikely to be of clinical benefit.5


4. Issues


4.1 Therapeutic risks

Patient wellbeing must be the primary consideration in determining whether to request particular tests. Unnecessary testing can expose patients to harm, impact patient flow, and result in inefficient use of clinical resources and excessive expenditure.5

Requesting tests for patients that are not clinically indicated or supported by evidence-based guidelines do not add any value to safe and effective patient care.

Unnecessary testing can be painful and lead to expensive and potentially dangerous treatment. It can result in overdiagnosis, where a medical condition is identified that would never cause the patient any harm. This may lead to a cascade of follow up tests and/or treatments, which cause physical harm and stress related to the outcome of serious procedures and anxiety about the real (or potential) loss of quality of life.3

4.2 Billing services to Medicare

In determining whether to bill a particular service to Medicare, GPs must consider whether there is clinical justification to do so. Section GN.1.2 of the MBS states that Medicare benefits are claimable only for ‘clinically relevant’ services rendered by an appropriate health practitioner.6 To meet this standard, the service being rendered must be accepted by the relevant health profession as necessary for the appropriate treatment of the patient. Fee and payment arrangements for tests that are not considered clinically relevant are a matter for discussion between practitioner and patient. Where a Medicare benefit has been inappropriately paid, Services Australia may request its return from the practitioner concerned.6

GPs can advise patients their CAM practitioner can privately request pathology tests, however, these will be outside of the Medicare system. Patients will incur the full cost of testing. As the requester, the CAM practitioner will be responsible for any follow up required.

4.3 Professional responsibility

Irrespective of billing arrangements, initiating tests at the request of a patient may expose GPs to medico-legal risk. GPs have a responsibility to review and take appropriate clinical action in response to the report generated by the request. However, in the event the original requestor is absent either during or outside normal business hours, a suitable delegate must be nominated to receive and act on the results.7 This responsibility cannot be delegated to a CAM or other practitioner. It is therefore important for GPs to consider whether they are familiar with the tests they are planning to request and are able to interpret the results.


5. Conclusion

Where patients attend their GP requesting specific pathology or medical imaging tests, whether on behalf of a CAM practitioner or by the patient themselves, patient wellbeing and clinical relevance must be the primary consideration when managing these requests.

If a decision is made to proceed with a test, GPs, as the requester, will be responsible for following up any results.

To assist GPs to explain these issues, the RACGP has developed a patient information sheet and template letter to CAM practitioners.


Related resources

Letter to CAM practitioners regarding appropriate diagnostic testing (PDF 31 KB)

RACGP Position Statement: Testing initiated by other health care clinicians

NPS MedicineWise: Choosing Wisely Australia 

First do no harm: a guide to choosing wisely in general practice 

 

Author: Practice Technology and Management
Contact: practicemanagement@racgp.org.au
Publication date: April 2025
Review date: 2028

  1. Breivold J, Isaksson Ro K, Hjorleifsson S. Conditions for gatekeeping when GPs consider patient requests unreasonable: a focus group study. Family Practice 2022;39(1):125-9.
  2. Services Australia. Pathology services for health professionals. Canberra: Services Australia, 2024. Available from: https://www.servicesaustralia.gov.au/pathology-services-for-health-professionals?context=20 (accessed 18 September 2024).   
  3. The Royal Australian College of General Practitioners. First do no harm: A guide to choosing wisely in general practice. East Melbourne: RACGP 2022. Available from: /clinical-resources/clinical-guidelines/key-racgp-guidelines/view-all-racgp-guidelines/first-do-no-harm/associated-topics/overdiagnosis (accessed 29 October 2024).
  4. Ekblad MO. How should a general practitioner say no to a patient? Scandinavian Journal of Primary Health Care 2023;41(4):353-4.
  5. Safer Care Victoria. No unnecessary tests (NUTs). Melbourne: Victorian Government 2020. Available from: https://www.safercare.vic.gov.au/best-practice-improvement/improvement-projects/medications-treatment-infection-prevention/no-unecessary-tests#:~:text=Unnecessary%20testing%20can%20expose%20patients,clinical%20resources%20and%20excessive%20expenditure (accessed 18 September 2024).
  6. Australian Government Department of Health and Aged Care. Medicare Benefits Schedule Book. Canberra: DoHAC, 2024.
  7. The Royal College of Pathologists of Australasia. The Pathology Request-Test-Report Cycle - Guidelines for Requestors and Pathology Providers. Surry Hills: RCPA 2022. Available from: https://www.rcpa.edu.au/getattachment/8c2134f8-9bcd-42ad-8d5e-bedd2b9ccbe4/Pathology-Request-Test-Report-Cycle-Guidelines.aspx (accessed 18 September 2024).

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