Most patients are understandably wary about signing up for
any surgical treatment options which a doctor offers, because they understand that these treatments
can be expensive and can have side effects. This is why they take a long time before
providing consent for any invasive treatment. Unfortunately, they don't utilize
the same skepticism when the doctor advises a panel of tests.
It is this unwillingness to question the need for tests
which causes so many problems today. The fact of the matter is that too many
doctors these days order too many tests. A lot of these tests are unnecessary, because
they don't provide any useful information - they don't really change your
treatment options, which is why they are pointless.
However, there is a lot of pressure on the doctor to do lots
of tests, and this comes from many sources.
Ironically, patients will put often put pressure on the
doctor, because they crave a diagnosis - they want to know what is wrong ! They
are worried that if the doctor cannot put a label on their disease, they will
not be able to treat it. This is why they're not happy when the doctor says,
" All the test results are fine," , because they think this means the
doctor is incompetent - after all, if he has not even been able to make the
correct diagnosis, how can he be trusted to provide the right treatment ?
Doctors are also quite happy to play with the newest diagnostic
toys, and when they attend a conference where a speaker waxes eloquent about
the latest tests, they want to try it on their patients as well . After all,
they want to remain on the cutting edge of medicine. The problem is that this
results in their patients bleeding, because the conference talking about a new
test is often out to promote it - either because he's the inventor, or because
he has been " sponsored" to say good things about the test by the
medical company which sells it. He talks at length about how cool it is , and how it's helped him to
find out the reasons for infertility in many couples, which other doctors have missed.
Doctors are still quite happy to use their patients as
guinea pigs, because they want to try out new stuff ! They also believe -
"What's the big deal about doing a test? Why don't I just go ahead and
order it. It'll hopefully provide us with more information , and we may be able
to use this in order to treat the patient's problem." This is just wishful thinking - after all, the
eye only sees what the mind knows.
And yes, doctors will often get cuts and kickbacks from
the lab, and this incentivises them to order lots of tests, which is why so
many of them subject their patients to "diagnostic panels" routinely
- whether they actually need them or not. However, not all this over-testing is
necessarily done with a bad intention.
The big problem is not the financial harm which this
causes to the patient. The much bigger danger is that a lot of these brand new
tests haven't been proven to be useful in clinical practice. Because they are new
, we don't understand what their limitations are. They've not been subjected to
controlled clinical trials to document they are beneficial in real life.
However, the problem is that the moment you do tests , you're bound to find
patients who have abnormal results. After all, that's what the purpose of doing
a test is - to pick up abnormalities, so that's the easy bit. However, managing
patients who have abnormal test results is exceedingly hard, because we don't
have enough clinical data to do so intelligently !
Not only do these abnormal results cause a lot of anxiety
in the patient, the doctor's knee-jerk reflex kicks in, and he wants to treat
the so-called abnormality. This means his focus is now on treating the abnormal
test result, rather than the patient. The moment he does this, he goes down the
slippery slope of over-treatment. These tests are plagued with the problems of false
positives - abnormal test results , which are completely unimportant and
irrelevant. However , once a doctor gets an abnormal result, he triumphantly
pronounces, "Ah, this is your problem. We found it!" The patient is
also very impressed that he has such a clever doctor who's helped her to
pinpoint what the problem is, and she's quite happy to take the treatment suggested,
without realizing that this doesn't really increase the chance of her getting
pregnant at all, because the test shouldn't have been done in the first place.
Unless patients learn to ask their doctor this simple
question - How will the results of this test change my treatment options? -
this problem is going to get even worse over time , especially with all the new
DNA based genetic tests which are being introduced left, right and center -
expensive tests which are looking for a patient to experiment on !