Medical Musings

Bienvenidos

Finally we can welcome the long awaited Radiology Clinic in Almuñécar, a very useful addition to the medical landscape in our little town, reducing the need of patients having to go to Motril for tests. Axel and I wish them success and a healthy growth, in patient numbers from inside and outside Almuñécar.

After some thought, I have changed my subject for this month (autism) because of a very surprising amount of positive feedback on my last article: Overtesting? Overtreating? Our secretary happily will print you a copy or you can read it in the Seaside Gazette online. The original article can be read in the New England Journal of Medicine March 17th 2011.

Axel and I have frequently written about the sense and nonsense of treatments, but hardly about tests. Tests are neither a magic wand to keep you healthy, nor to detect illness. For example everybody agrees on fasting blood sugar testing, but what does a normal result say? Everything and nothing. As a single test it may be useful to screen for diabetes, but a normal test does still not exclude it entirely.

Frequent testing is useful in monitoring diabetes, but occasional testing to monitor diabetes is, except in minor illness, a waste of time. A blood sugar test gives you a reading, which might not be true within half an hour, it may fall or rise rapidly with food or exercise, thus it will always be a single snapshot of your life.

A normal liver function test – yeah, the alcohol has not damaged the liver, yet! Wrong, up to a third of alcoholics may not have abnormal tests. Normal values will also not exclude liver cancer, metastases or gallstones for example and even a chronic hepatitis may be missed with a single check. On the other hand a normal ultrasound scan does not necessarily mean that your liver is working normally.

ECGs… well I would like to have a normal one, but that does not mean that I can’t die from a heart attack an hour later, because as long as the heart muscle has sufficient oxygen supply nothing abnormal will show on the ECG.

Slipped disc? Take people from the street, do a CT scan and you will find, that every third person has got one. And you equally will find that most of them will disappear again without anybody having ever noticed them.

An x-ray for a painful back? Well, your elderly neighbour probably has a worse one, although he is the picture of health.

Blood tests for many types of cancer like bowel, pancreas, liver, breast or ovaries never will exclude the possibility that you suffer from any of those, but once they are positive they serve as an elegant tool to monitor the progress of treatment.

There are patients who want to know anyway, others only want tests when they could change the management of their problem – both a valid approach, because “knowing for certain” can make you feel better. But tests also can make you feel worse, because test results can be wrong. Occasionally they don’t flag up what they should, reassuring you where they should not, more frequently they ring the alarm bells leading to more tests which often are more invasive and frequently causing undue pain and worry even psychosomatic illness.

Tests are important but you have to know the limitations of tests and the things they don’t tell you, because they are the wrong tool for your problem; and you always have to put tests into the context of the situation. This way everybody can be assured to get the best out of a test.

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