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Tests fall into two broad categories: screening and diagnostic.
A screening test is used when it has been shown that doing the test for someone with no symptoms has benefit in finding a potentially serious condition at a point when treatment could prevent a more serious condition later. Example: colonoscopy.
A diagnostic test is done when there are symptoms. Example: colonoscopy for someone with rectal bleeding.
Each test should have an indication. For a screening colonoscopy, that could be simply age over 50 years. For someone with a family history of colon cancer the age for the first test could be lower. It has to be individualized for the patient.
Anyone is free to decline any test, but it is best to be sure you know the reason the test is being offered before you refuse to have it, particularly if you are having symptoms that generate concern for a serious problem.
When the testing is being done because of symptoms, doctors do want to zero in on a diagnosis in the most expeditious fashion. They will choose the battery of tests that is most likely to find a cause for a particular set of symptoms. That some of those tests are normal does not mean they were not indicated. You cannot know they will be normal until after they are done.
Yes, some testing is for CYA reasons. Go to an ER with a headache and you will almost certainly get your head scanned, because you made the decision that your headache was bad enough to need emergency care.
Excellent explanation, as always, SusyQ.
Along the same vein as the colonoscopy example, here's another example with recent experience I had with screening vs. diagnostic testing. Last summer, as part of my annual physical, I was given an occult blood card with instructions to fill it out (), send it back to the doc's office. I took it home, threw it in a drawer and promptly forgot about it and assumed the docs office would too. Then a couple months ago, I got another occult blood card in the mail from my doc's office, with instructions to use it, return it, and that it was "required by my insurance company (don't know about that) and the insurance would pay for it. That card was followed by a phone call, and email, and two portal messages. I could have stopped the process by stating I refused it, but I know better, so I complied with the instructions and sent the thing back to them. I figured that was the colon cancer screening test, it would be negative, and glory halleluia, no colonoscopy needed (I had one 10 yrs ago at age 60 which was normal).
Well, no such luck, as my doctor called about a week later to inform me the occult blood was positive, that I needed to get a colonoscopy and that she had already sent a referral to the doctor she wanted me to see. I felt a bit railroaded there, but I know she was right and I would have asked her for a referral anyway. So I made the appointment, the doc had my records, said he would do a colonoscopy (which since it's now looking for a source of bleeding is diagnostic, not screening even though they also look for cancers), but that I should also consider an upper endoscopy (EGD) because if they didn't find the source of that occult blood in the colonoscopy I would most likely need to return for the EGD. But he left it up to me, I waffled as he answered my questions, and finally I consented to the EGD in addition to the colonoscopy. That was obviously the right answer, as this doc told me he was concerned about not just the GI bleeding but the anemia I have as well.
So it all went well (with both the EGD and the colonoscopy being diagnostic, I'd say,), and as for the source of bleeding? Well, it wasn't in the colon, so it was a good thing to have had the EGD. They found gastric erosion, with multiple bleeding spots. Not cancer, thank goodness, but I'm now being treated for the gastritis and bleeding.
I'm not so sure I ever would have had that vague pain I felt checked out-would just have chalked it up to the vicissitudes of old age- until it got much worse, but I'm glad things turned out as they did.
Along the same vein as the colonoscopy example, here's another example with recent experience I had with screening vs. diagnostic testing. Last summer, as part of my annual physical, I was given an occult blood card with instructions to fill it out (), send it back to the doc's office. I took it home, threw it in a drawer and promptly forgot about it and assumed the docs office would too. Then a couple months ago, I got another occult blood card in the mail from my doc's office, with instructions to use it, return it, and that it was "required by my insurance company (don't know about that) and the insurance would pay for it. That card was followed by a phone call, and email, and two portal messages. I could have stopped the process by stating I refused it, but I know better, so I complied with the instructions and sent the thing back to them. I figured that was the colon cancer screening test, it would be negative, and glory halleluia, no colonoscopy needed (I had one 10 yrs ago at age 60 which was normal).
Well, no such luck, as my doctor called about a week later to inform me the occult blood was positive, that I needed to get a colonoscopy and that she had already sent a referral to the doctor she wanted me to see. I felt a bit railroaded there, but I know she was right and I would have asked her for a referral anyway. So I made the appointment, the doc had my records, said he would do a colonoscopy (which since it's now looking for a source of bleeding is diagnostic, not screening even though they also look for cancers), but that I should also consider an upper endoscopy (EGD) because if they didn't find the source of that occult blood in the colonoscopy I would most likely need to return for the EGD. But he left it up to me, I waffled as he answered my questions, and finally I consented to the EGD in addition to the colonoscopy. That was obviously the right answer, as this doc told me he was concerned about not just the GI bleeding but the anemia I have as well.
So it all went well (with both the EGD and the colonoscopy being diagnostic, I'd say,), and as for the source of bleeding? Well, it wasn't in the colon, so it was a good thing to have had the EGD. They found gastric erosion, with multiple bleeding spots. Not cancer, thank goodness, but I'm now being treated for the gastritis and bleeding.
I'm not so sure I ever would have had that vague pain I felt checked out-would just have chalked it up to the vicissitudes of old age- until it got much worse, but I'm glad things turned out as they did.
And that's the way it's supposed to work, folks!
Diagnosis made (before a possible massive bleed from the stomach) and a treatment plan started and a patient who should feel better soon.
I always seek honest answers. As Neil Young said "I was thinking about what a friend had said, hoping it was a lie." But I'd rather hear it.
My difficulty comes when the tests would change nothing.
As always I thank everyone for their answers or thoughts.
That's why you ask: what is the purpose of this test, and how would it change my outcome? What are the probabilities? The more you ask, the more you know. Before I had my prostate biopsy, I researched the topic and went into my urologist with a host of questions. That's called being a smart consumer of medical care.
I take the same approach with medications. I was having a problem several years ago (I think it was related to joint pain) and the doctor wrote a couple of prescriptions. I researched them - and one of them was related to a drug that had caused cardiovascular problems in some patients. I went back for a follow up visit, said I hadn't filled the prescription, and discussed what I had found online. He told me it wasn't exactly the same drug so there wasn't data suggesting it had the same problems as the related drug, so my not filling it was "probably a good idea".
Point being -- docs aren't evil money hungry pill pushers, they're folks who often went into the medical professions to help people. That's why I became a licensed mental health professional -- not because it would mean I'd be rolling in the dough. As I said, due to managed care, physicians today tend to have huge numbers of patients to deal with particularly if they're specialists. Burn out is high:
Quote:
“‘Six doctors have left this year,’ said Dr. Keith White, a 22-year pediatrician. ‘We were not ready for EPIC and EPIC was not ready for us,’ White told supervisors. ‘As a result, the providers are struggling to provide safe and effective care for 100,000 citizens of the county, many of whom are very ill. We often feel that we are failing. We are very tired ... many doctors have left and all are considering leaving.’â€
In my experience, treat doctors with respect, as fellow human beings rather than adversaries, and take co-ownership of your treatment by becoming and staying informed and communicating with your providers and you'll be much happier with your outcomes.
If I have a really sore throat that is not getting better it might just be a virus or it might be strep, the only way to know for sure is to check for strep. If I get winded easily it might just be because I don't engage in enough aerobic activity, or it might be that I have a heart condition. I prefer not to go to doctors who try to "guess" at what's wrong with me.
And that incident with slurring your words and problems typing, as someone else said that sounds like a TIA which is definitely not something you should try to treat on your own.
Quite true on both counts. So why not just treat the TIA given that it is mutually obvious?
Quite true on both counts. So why not just treat the TIA given that it is mutually obvious?
There are two kinds of strokes: those due to blockage of an artery (ischemic stroke) and those due to bleeding (hemorrhagic stroke). Medication given for ischemic stroke could worsen a hemorrhagic stroke.
TIA symptoms could be associated with a small hemorrhagic stroke.
"'Small intracerebral hemorrhages can present with temporary symptoms that are difficult to distinguish from a TIA in the absence of brain imaging,' first author Sandeep Kumar, MD, from the Department of Neurology, Stroke Division, Beth Israel Deaconess Medical Center, Boston, Massachusetts, told Medscape Medical News.
'The main message is that all patients with such clinical presentation should be imaged promptly and no one should be prescribed antithrombotic agents before eliminating a hemorrhage with a CT [computed tomographic] scan or a brain MRI,' he said."
There are two kinds of strokes: those due to blockage of an artery (ischemic stroke) and those due to bleeding (hemorrhagic stroke). Medication given for ischemic stroke could worsen a hemorrhagic stroke.
TIA symptoms could be associated with a small hemorrhagic stroke.
"'Small intracerebral hemorrhages can present with temporary symptoms that are difficult to distinguish from a TIA in the absence of brain imaging,' first author Sandeep Kumar, MD, from the Department of Neurology, Stroke Division, Beth Israel Deaconess Medical Center, Boston, Massachusetts, told Medscape Medical News.
'The main message is that all patients with such clinical presentation should be imaged promptly and no one should be prescribed antithrombotic agents before eliminating a hemorrhage with a CT [computed tomographic] scan or a brain MRI,' he said."
Diagnosis made (before a possible massive bleed from the stomach) and a treatment plan started and a patient who should feel better soon.
Amen! With any luck, hopefully.
And I have to extend kudoes to the docs (the primary and the surgeon she referred me to) who were very patient with me as I worked through my tendency to assume I know it all, and to be so sure that there is nothing wrong and all this is not necessary. They explained everything well, and let me come to my own conclusions. Kind of a lesson in humility, I think.
And I have to extend kudoes to the docs (the primary and the surgeon she referred me to) who were very patient with me as I worked through my tendency to assume I know it all, and to be so sure that there is nothing wrong and all this is not necessary. They explained everything well, and let me come to my own conclusions. Kind of a lesson in humility, I think.
When I developed a small bowel obstruction I sat up all night trying to convince myself that I had nothing but a garden variety GI issue that would resolve by itself. Denial is a powerful thing! When I finally went to the ER it was fortunately not busy. I was seen by the ER doc, had an X-ray and then a CT scan, and was very quickly in the OR. The surgeon bumped me to the top of the schedule when he saw the scan.
I was chastised (politely - the surgeon is a nice guy!) for not coming in sooner! He did not have to remove any bowel, but it was a close thing. Waiting much longer might have made that necessary.
When I developed a small bowel obstruction I sat up all night trying to convince myself that I had nothing but a garden variety GI issue that would resolve by itself. Denial is a powerful thing! When I finally went to the ER it was fortunately not busy. I was seen by the ER doc, had an X-ray and then a CT scan, and was very quickly in the OR. The surgeon bumped me to the top of the schedule when he saw the scan.
I was chastised (politely - the surgeon is a nice guy!) for not coming in sooner! He did not have to remove any bowel, but it was a close thing. Waiting much longer might have made that necessary.
Sounds as though you dodged a bullet there! But I completely understand the tendency to 1) think that pain you're feeling can't really be as bad as you think it is, and/or 2) think it *must* be a virus, an age related thing that happens to everyone and 3)it will get better or go away given enough time.
Glad you didn't wait qny longer than you did and didn't need any bowel removed. I'm sure it wasn't any fun in any case.
Sounds as though you dodged a bullet there! But I completely understand the tendency to 1) think that pain you're feeling can't really be as bad as you think it is, and/or 2) think it *must* be a virus, an age related thing that happens to everyone and 3)it will get better or go away given enough time.
Glad you didn't wait qny longer than you did and didn't need any bowel removed. I'm sure it wasn't any fun in any case.
It wasn't fun but the recovery was fairly easy. I felt much better after the surgery, that's for sure. I left the hospital after a few days with stern instructions not to overdo it.
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), send it back to the doc's office. I took it home, threw it in a drawer and promptly forgot about it and assumed the docs office would too. Then a couple months ago, I got another occult blood card in the mail from my doc's office, with instructions to use it, return it, and that it was "required by my insurance company (don't know about that) and the insurance would pay for it. That card was followed by a phone call, and email, and two portal messages. I could have stopped the process by stating I refused it, but I know better, so I complied with the instructions and sent the thing back to them. I figured that was the colon cancer screening test, it would be negative, and glory halleluia, no colonoscopy needed (I had one 10 yrs ago at age 60 which was normal). 
