GrizzleAlberto789

Even superb tools can be mis-used. Here are seven "sins" of healthcare testing:

1. Ordering the wrong test for the proper situation.

If I had a nickel for every time a doctor ordered a carotid artery test in a patient with a fainting spell, I could fund my retirement numerous occasions more than. And this is despite the fact that troubles with the carotid arteries (the pulsating blood-vessels in the front of the neck) are incapable of creating fainting spells! Narrowed or blocked carotid arteries are capable of creating numerous other symptoms -- including paralysis on a single side of the body or loss of speech -- but not unconsciousness. But this test is regularly ordered in a knee-jerk fashion for folks with fainting spells. Furthermore, when the artery is discovered to be narrowed, it often triggers a needless and risky operation on the affected artery. All due to the fact of a test that shouldn't have been ordered in the very first place!

2. Treating the test instead of the patient.

There are circumstances in which a tool gets confused with a objective. A single example of this is in the remedy of individuals with epileptic seizures. Most individuals with seizures do well with the help of seizure-suppressing medications. The amount, or level, of some of these medicines can be measured in the bloodstream and there are circumstances in which it is helpful to do so. A drug level can be a useful tool. But it's only a tool, and nothing at all a lot more.

The goals of seizure therapy are easy -- no seizures and no side-effects. What could be much more straightforward? However, some physicians seem to believe that the purpose of remedy is to produce a particular drug level on a lab report. When this happens, problems can ensue. For instance, a patient might be performing excellent on a particular dose of a medication that stops his or her seizures without causing side effects. (How can 1 improve on that?) But then a doctor, ordering a drug level due to the fact it appears like the right factor to do, feels compelled by the quantity appearing on the lab slip to lower the dose of medication. When this happens, a seizure often final results. This is a seizure that did not need to have to come about.

3. Making use of a test as a substitute for interacting with the patient.

I have wonderful respect for emergency physicians. Getting carried out emergency perform myself, I know it is not an straightforward job. Emergency physicians function in a fish bowl, topic to criticism and second-guessing for choices made in crisis circumstances and below stress of time. That mentioned, a single gains the impression that often they order thousands of dollars worth of tests primarily based on a 30-second interview and a cursory exam. Yet there are cases in which, if a couple of a lot more queries had been asked of the patient or family, the diagnostic possibilities and selection of tests would have changed.

four. Ordering irrelevant tests.

There are certain tests -- like a chloride level in spinal fluid or blood-levels of some of the newer seizure-preventing drugs -- that are not known to be helpful 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-outcomes are handled as if they are perfect and never ever wrong. As an instance, occasionally sufferers have attacks for which the descriptions are compelling for a diagnosis of seizures, but then have standard electroencephalograms (brain-wave tests). Electoencephalograms can be very valuable, but it really is feasible for a patient who really does have seizures to have a typical tracing. Yet it really is not unusual to encounter circumstances exactly where patients' standard brain-wave tests kept them from receiving the remedies they needed.

six. Forgetting that there are not tests for each healthcare condition.

When individuals report tough-to-diagnose symptoms to their doctors, healthcare tests are typically ordered. At times all the test-outcomes are regular. Does this mean there is nothing wrong with the patient? Not necessarily. There are several situations -- like migraine, Parkinson's illness, fibromyalgia and restless legs syndrome -- for which standard tests show no abnormality. We just don't have tests for almost everything. So it can take place that the tests are standard, but the patient is not.

7. Failing to order tests that could influence therapy.

One particular axiom of healthcare management is that a test need to only be completed if its different outcomes would lead to different plans of action. If the plan of action is the 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 distinct outcomes would indeed lead to various plans of action, then the test really must be accomplished, or at least be strongly regarded as. So, when it comes to ordering a test, there can be sins of omission as effectively as sins of commission.

It is tragic when a patient develops progressive memory loss and confusion. But it is even much more tragic when it is assumed that the lead to is Alzheimer's illness (for which there is no very good treatment) when it's really due to one thing else for which very good treatment is offered. A risk-free of charge head scan and a tiny assortment of blood tests can verify for a number of curable circumstances, but at times these tests are omitted.

(C) 2006 by Gary Cordingley open site in new window