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

1. Ordering the incorrect test for the correct condition.

If I had a nickel for each and every time a medical professional ordered a carotid artery test in a patient with a fainting spell, I could fund my retirement several occasions over. And this is regardless of the reality that problems 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 -- such as paralysis on a single side of the physique or loss of speech -- but not unconsciousness. But this test is regularly ordered in a knee-jerk style for folks with fainting spells. Moreover, when the artery is identified to be narrowed, it sometimes triggers a needless and risky operation on the impacted artery. All since of a test that shouldn't have been ordered in the initial place!

two. Treating the test instead of the patient.

There are circumstances in which a tool gets confused with a goal. One particular example of this is in the remedy of men and women with epileptic seizures. Most men and women with seizures do properly with the support of seizure-suppressing drugs. The quantity, or level, of some of these drugs can be measured in the bloodstream and there are situations in which it is beneficial to do so. A drug level can be a useful tool. But it is only a tool, and nothing far more.

The ambitions of seizure treatment are simple -- no seizures and no side-effects. What could be a lot more simple? Nevertheless, some physicians appear to think that the goal of therapy is to create a specific drug level on a lab report. When this occurs, problems can ensue. For instance, a patient might be undertaking excellent on a specific dose of a medication that stops his or her seizures without causing side effects. (How can 1 increase on that?) But then a medical doctor, ordering a drug level due to the fact it appears like the appropriate issue to do, feels compelled by the number appearing on the lab slip to lower the dose of medication. When this occurs, a seizure often outcomes. This is a seizure that did not require to occur.

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

I have excellent respect for emergency physicians. Getting completed emergency perform myself, I know it's not an straightforward job. Emergency physicians function in a fish bowl, topic to criticism and second-guessing for choices produced in crisis conditions and beneath pressure of time. That mentioned, a single 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 cases in which, if a couple of more queries had been asked of the patient or loved ones, the diagnostic possibilities and option 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-stopping drugs -- that are not identified to be valuable for anything. But they get ordered anyway.

five. Forgetting that tests are imperfect.

All tests -- from higher-tech scans to lowly blood measurements -- have false-positives (overcalls) and false-negatives (undercalls). But occasionally test-results are handled as if they're perfect and never wrong. As an example, sometimes 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 very useful, but it's achievable for a patient who genuinely does have seizures to have a standard tracing. Yet it really is not uncommon to encounter situations where patients' normal brain-wave tests kept them from getting the therapies they required.

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

When individuals report challenging-to-diagnose symptoms to their medical doctors, medical tests are often ordered. Sometimes all the test-final results are regular. Does this imply there is absolutely nothing incorrect with the patient? Not necessarily. There are many conditions -- like migraine, Parkinson's illness, fibromyalgia and restless legs syndrome -- for which traditional tests show no abnormality. We just do not have tests for every thing. So it can take place that the tests are typical, but the patient is not.

7. Failing to order tests that could have an effect on treatment.

One axiom of health-related management is that a test ought to only be carried out if its different outcomes would lead to different plans of action. If the strategy of action is the identical 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 indeed lead to distinct plans of action, then the test actually should be carried out, or at least be strongly regarded. So, when it comes to ordering a test, there can be sins of omission as nicely as sins of commission.

It is tragic when a patient develops progressive memory loss and confusion. But it is even more tragic when it is assumed that the lead to is Alzheimer's disease (for which there is no great therapy) when it's genuinely due to anything else for which good treatment is available. A risk-free head scan and a small assortment of blood tests can check for a number of curable circumstances, but sometimes these tests are omitted.

(C) 2006 by Gary Cordingley details