Source: www.usatoday.com Author: Mary Brophy Marcus In the past, most patients placed their entire trust in the hands of their physician. Your doc said you needed a certain medical test, you got it. Not so much anymore. Jeff Chappell of Montgomery, Ala., recalls a visit a couple of years ago to a Charlotte emergency room, near where the family used to live, with his wife, Jacqueline, who has adrenal failure. "I blew up loud enough for everyone in the ER to hear me explain that while we were insured, an MRI was about a $1,000 co-pay," Chappell says. The couple knew her symptoms well (primarily stomach pain), knew that an MRI was not necessary under the circumstances and knew that a cortisone shot was what she needed. "The doctor walked off in a huff," Chappell says, but later came back and "compromised" by agreeing to give his wife the shot, but not before taking an abdominal X-ray to rule out other problems first. Many physicians say an increasing number of patients are getting involved in decisions about their medical care, including medication choices, whether they need a specialist, and especially whether they need expensive diagnostic tests, which some health economists say are driving up the cost of health care. 'Shared decision model' "There have been big changes," says Patrick McManus, residency director of family and community medicine at Thomas Jefferson University in Philadelphia. "Some of my older patients are still more deferential, but more and more, we talk with patients [...]