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Even excellent tools can be mis-utilised. Here are seven "sins" of medical testing:

1. Ordering the incorrect test for the proper condition.

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 several occasions more than. And this is regardless of the fact that difficulties with the carotid arteries (the pulsating blood-vessels in the front of the neck) are incapable of producing fainting spells! Narrowed or blocked carotid arteries are capable of producing many other symptoms -- including paralysis on one particular side of the physique or loss of speech -- but not unconsciousness. However this test is often ordered in a knee-jerk style for men and women with fainting spells. In addition, when the artery is discovered to be narrowed, it at times triggers a needless and risky operation on the impacted artery. All since of a test that shouldn't have been ordered in the 1st place!

2. Treating the test as an alternative of the patient.

There are circumstances in which a tool gets confused with a objective. One particular instance of this is in the treatment of folks with epileptic seizures. Most men and women with seizures do nicely with the help of seizure-suppressing drugs. The amount, or level, of some of these drugs can be measured in the bloodstream and there are circumstances in which it is beneficial to do so. A drug level can be a beneficial tool. But it really is only a tool, and absolutely nothing more.

The ambitions of seizure treatment are straightforward -- no seizures and no side-effects. What could be more simple? Nevertheless, some physicians seem to believe that the objective of treatment is to generate a certain drug level on a lab report. When this happens, difficulty can ensue. For example, a patient may well be doing great on a particular dose of a medication that stops his or her seizures with out causing side effects. (How can one improve on that?) But then a medical professional, ordering a drug level due to the fact it seems like the proper point to do, feels compelled by the quantity appearing on the lab slip to lower the dose of medication. When this happens, a seizure sometimes final results. This is a seizure that did not want to occur.

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

I have fantastic respect for emergency physicians. Obtaining completed emergency work myself, I know it is not an easy job. Emergency physicians perform in a fish bowl, topic to criticism and second-guessing for choices made in crisis scenarios and below pressure of time. That mentioned, a single gains the impression that occasionally they order thousands of dollars worth of tests based on a 30-second interview and a cursory exam. Yet there are circumstances in which, if a few a lot more inquiries had been asked of the patient or family, the diagnostic possibilities and decision of tests would have changed.

4. Ordering irrelevant tests.

There are particular 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 valuable for anything. But they get ordered anyway.

5. Forgetting that tests are imperfect.

All tests -- from high-tech scans to lowly blood measurements -- have false-positives (overcalls) and false-negatives (undercalls). But sometimes test-benefits are handled as if they are ideal and never wrong. As an instance, sometimes patients have attacks for which the descriptions are compelling for a diagnosis of seizures, but then have standard electroencephalograms (brain-wave tests). Electoencephalograms can be extremely useful, but it's possible for a patient who actually does have seizures to have a normal tracing. However it's not uncommon to encounter circumstances exactly where patients' standard brain-wave tests kept them from receiving the remedies they necessary.

six. Forgetting that there are not tests for every health-related situation.

When sufferers report tough-to-diagnose symptoms to their medical doctors, healthcare tests are frequently ordered. At times all the test-benefits are normal. Does this mean there is nothing at all incorrect with the patient? Not necessarily. There are several conditions -- like migraine, Parkinson's illness, fibromyalgia and restless legs syndrome -- for which standard tests show no abnormality. We just do not have tests for every little thing. So it can come about that the tests are typical, but the patient isn't.

7. Failing to order tests that could impact remedy.

A single axiom of healthcare management is that a test must only be carried out if its distinct outcomes would lead to various plans of action. If the program of action is the exact same no matter how the test turns out, then why do the test? There's a flip side to this axiom. If a test's various outcomes would indeed lead to various plans of action, then the test really need to be completed, or at least be strongly deemed. 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's even much more tragic when it is assumed that the result in is Alzheimer's illness (for which there is no very good treatment) when it really is actually due to some thing else for which good treatment is available. A threat-free of charge head scan and a little assortment of blood tests can check for a number of curable situations, but sometimes these tests are omitted.

(C) 2006 by Gary Cordingley aaron parkinson