Sometimes, it order to avoid a costly and unnecessary work up, you have to have an intervention with a patient. Not a “stop drinking” or “stop cocaine” intervention, but a “you don’t need any more testing, you will get better on your own” one. I have a pretty good success rate with these but it comes at a price. You have to spend an inordinate amount of time doing it. The other day I convinced one family that mom did not need her second CT scan for her third visit in a month for benign positional vertigo. I had to spend 15 minutes explaining the disorder,the treatment, and most importantly, what her expectations for recovery should be (ie, it won’t get better instantly, even with antivert). I got backed up with other patients but felt good that I avoided another run of blood tests and head CT. Later the same shift I spent even more time telling a healthy young guy why he did not need another EKG, CT, and MRI, and or repeat blood work for his second episode of vasovagal syncope. Trying to explain the autonomic nervous system in a way that a lay person can understand can be challenging enough – but when they ask a hundred questions, before you know it, you are 5 more patients in the hole. Well, at least that was towards the end of my shift and the guy felt “educated” enough about the condition to use the term “micturition syncope” in dinner conversation. And, I saved his health plan a crap load of money!