Monday, 4 February 2008

Testing, testing

The BBC reported on Saturday that junior doctors cheerfully order tests to be carried out even when they know that the results wouldn't mean a thing to them. The report didn't say if juniors were confident that someone else would come along to interpret the test. Perhaps they just feel they ought to be doing something when they are baffled and that patients will be reassured to hear "we're running some tests".

Could patient pressure be to blame? There's a story in today's Telegraph about a little girl diagnosed with cancer. Initially no one seemed to know the cause of her aches and pains and in the end a journalist suggested that the mother "demand blood a test." There is no indication of what kind of blood test - blood can be tested for many things. Is this patient power at an extreme? What else could we demand?

Apparently too many patients demand antibiotics for colds - which are, of course, viral, and therefore do not respond to antibiotics. In the mean time the overuse and abuse of antibiotics leads to ever more horror stories about flesh eating, drug resistant bugs.

Is there a balance needed between the patient's right to be involved and the need to respect the knowledge and training of a doctor or other healthcare professional? On the one hand we have the concept of the expert patient. Most geriatricians aren't old, rheumatologists don't generally have arthritis, and many obstetricians are male. The patient is the person who lives with a disease - especially chronic illness - day in and day out. Surely in some ways they know more about that illness than their healthcare provider?

On the other hand there is the pesky know-it-all patient who has looked up their symptoms on the internet and has only come to tell you what to prescribe for them. My favourite example of this is the cartoon of the chap in his GP's surgery with an internet diagnosis. The GP remarks "I sometimes wonder why I spent 10 years training to become a GP. Your analysis and medication would work perfectly...if you were a goat"

Doctors aren't alone in this. Parents ring up schools to explain to dimwit teachers that they have given their child the wrong grade for their homework or course work. And surely we're all familiar with the joke about the garage tariff with the most expensive price being for work done "with customer's advice"?

One way to help patients be experts rather than pests is to point them towards websites that provide them with good quality health information, like NHS Choices, Patient UK and BBC Health. Help them understand how to evaluate information - perhaps using the QUICK quality information checklist, pointing out the HoN logo or telling them about the Quackwatch site that rounds up and explains the worst urban myths, scare stories, and lies around health.

The other way to avoid the pest is to listen to them and try to work with them, not against them. There are plenty of books on communicating with patients - it really is the key to a good patient/healthcare professional relationship.

And for those of you still struggling with the meaning of lab tests - read up on it in the library. We recommend A Guide to Laboratory Investigations, the Oxford Handbook of Clinical and Laboratory Investigation and Understanding Laboratory Investigations. On the net you'll find the Lab Tests Online resource.

(c) creative commons attributed

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