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Even excellent tools can be mis-utilized. Here are seven "sins" of health-related testing:

1. Ordering the incorrect test for the appropriate condition.

If I had a nickel for each time a physician ordered a carotid artery test in a patient with a fainting spell, I could fund my retirement several occasions more than. And this is in spite of the fact that troubles with the carotid arteries (the pulsating blood-vessels in the front of the neck) are incapable of generating fainting spells! Narrowed or blocked carotid arteries are capable of producing numerous other symptoms -- like paralysis on one side of the physique or loss of speech -- but not unconsciousness. However this test is frequently ordered in a knee-jerk style for men and women with fainting spells. Moreover, when the artery is identified to be narrowed, it occasionally triggers a needless and risky operation on the impacted artery. All due to the fact of a test that should not have been ordered in the first spot!

2. Treating the test rather of the patient.

There are conditions in which a tool gets confused with a purpose. One particular instance of this is in the remedy of people with epileptic seizures. Most folks with seizures do properly with the aid of seizure-suppressing medicines. The quantity, or level, of some of these medicines can be measured in the bloodstream and there are circumstances in which it is valuable to do so. A drug level can be a helpful tool. But it's only a tool, and absolutely nothing far more.

The objectives of seizure remedy are straightforward -- no seizures and no side-effects. What could be much more straightforward? Even so, some physicians seem to believe that the aim of remedy is to generate a certain drug level on a lab report. When this occurs, trouble can ensue. For example, a patient may possibly be doing fantastic on a particular dose of a medication that stops his or her seizures with no causing side effects. (How can 1 increase on that?) But then a doctor, ordering a drug level simply because it seems like the proper thing to do, feels compelled by the quantity appearing on the lab slip to reduced the dose of medication. When this happens, a seizure occasionally benefits. This is a seizure that didn't require to occur.

three. Employing a test as a substitute for interacting with the patient.

I have fantastic respect for emergency physicians. Possessing done emergency operate myself, I know it is not an straightforward job. Emergency physicians work in a fish bowl, subject to criticism and second-guessing for choices made in crisis circumstances and under pressure of time. That mentioned, one gains the impression that at times they order thousands of dollars worth of tests primarily based on a 30-second interview and a cursory exam. However there are instances in which, if a handful of more inquiries had been asked of the patient or loved ones, the diagnostic possibilities and selection of tests would have changed.

4. Ordering irrelevant tests.

There are specific tests -- like a chloride level in spinal fluid or blood-levels of some of the newer seizure-stopping drugs -- that are not recognized to be valuable for something. But they get ordered anyway.

5. Forgetting that tests are imperfect.

All tests -- from higher-tech scans to lowly blood measurements -- have false-positives (overcalls) and false-negatives (undercalls). But at times test-benefits are handled as if they are excellent and by no means incorrect. As an instance, occasionally patients have attacks for which the descriptions are compelling for a diagnosis of seizures, but then have normal electroencephalograms (brain-wave tests). Electoencephalograms can be quite useful, but it really is feasible for a patient who really does have seizures to have a standard tracing. Yet it's not uncommon to encounter situations where patients' standard brain-wave tests kept them from getting the remedies they needed.

6. Forgetting that there aren't tests for each and every health-related situation.

When individuals report challenging-to-diagnose symptoms to their doctors, health-related tests are frequently ordered. Occasionally all the test-results are typical. Does this mean there is nothing at all incorrect with the patient? Not necessarily. There are a lot of situations -- like migraine, Parkinson's disease, fibromyalgia and restless legs syndrome -- for which conventional tests show no abnormality. We just don't have tests for almost everything. So it can come about that the tests are typical, but the patient is not.

7. Failing to order tests that could impact therapy.

One particular axiom of medical management is that a test need to only be accomplished if its various outcomes would lead to different plans of action. If the strategy of action is the very same no matter how the test turns out, then why do the test? There is a flip side to this axiom. If a test's different outcomes would certainly lead to various plans of action, then the test truly should be carried out, or at least be strongly considered. So, when it comes to ordering a test, there can be sins of omission as well as sins of commission.

It is tragic when a patient develops progressive memory loss and confusion. But it really is even far more tragic when it is assumed that the trigger is Alzheimer's disease (for which there is no good treatment) when it's really due to some thing else for which great treatment is obtainable. A danger-free head scan and a modest assortment of blood tests can check for a quantity of curable situations, but often these tests are omitted.

(C) 2006 by Gary Cordingley aaron parkinson