Tyranny of the Test

As I mentioned recently, testing is one of the hallmarks of personalized medicine. These days there are so many tests to help zero in on what’s really happening in your body. When used judiciously, test results can provide comprehensive information which helps your doctor or health coach develop an individualized plan for you.

Lab testing

Image via NPR

Thanks to technology, doctors are able to see images of your heart and carotid arteries in action, graphs showing a heart under the stress of walking up an incline, and more graphs of your heart beats and blood pressure during daily activities. They can see your brain in glorious colour and your body in three dimensions. They’re able to monitor the level of all manner of things in your blood. They can measure good and bad bugs in your gut, and find out if you have genes that predispose you to certain conditions you’d rather not know about.

Sounds like a good thing?

Maybe yes, maybe no.

Yes, it provides a lot of information. But sometimes it’s too much information … and that comes with its own burdens.

The thing is, when we have information, it usually means we have to process it and make decisions. That’s challenging because in medicine and health, answers are not clearcut.

For example, a pregnant mother is told a test shows a 5% chance that her baby has a particular birth defect. What is she supposed to do with that information? How is it helpful?!! The worry it sets up can only be detrimental to both mother and the unborn baby. The internal conflicts it sets up must be awful.

Let’s keep a sense of proportion

The above example is a true story, told to me by that woman a year after giving birth to her baby—a healthy boy. There are lessons we can learn from how she responded in this difficult situation.

  • To the doctor, she said: “Then that means there’s a 95% chance this baby is healthy.” She saw what was right in the situation, not what was wrong. That’s a principle we would all do well to remember.
  • Then she sought a second opinion, selecting the source judiciously. She had grown up in Europe, where the cultural approach to health leans more toward common sense. Still having family there, she sent the test results to a doctor back home. If she had consulted another doctor in Canada, the second opinion would likely have come from the same perspective as the first. Not all of us have access to a trusted second opinion in another country. But we can discuss test results with an integrative or functional doctor, whose professional culture fosters a broader perspective. That’s what I did when my GP and specialist were pressuring me to take statins.

Before having a test, we need to think what we will we do with the information when we have it. Case in point: In the flurry of concern following Angelina Jolie’s preventive double mastectomy because she has a particular gene, a friend was investigating how to get tested for that gene. She was concerned because her mother and grandmother both had breast cancer.

Her mother, a nurse with plenty of common sense, asked if she had considered what she would do if she does have the gene. Would she go through the trauma of a double mastectomy just in case? If she wouldn’t, why have the test and spend the rest of her life waiting for the axe to fall? It seems to me that sometimes it’s better not to know, and deal with things if and when they arise. After all, we can’t control everything in life and we can give ourselves a lot of grief trying.

Sometimes common sense has to prevail. Last year an internist was adamant that I had to take statins because my blood test showed elevated cholesterol. To emphasize her point, she told me I had a 20% of dying of a heart attack or stroke in the next ten years. My reply was: “I am 69 years old. I’d say there’s more than a 20% chance I’ll die within the next ten years.”

Tests don’t tell the whole story

In my first blog about navigating the health care culture, I described my desperate situation following thyroid removal and medication with Synthroid. Four months after surgery, I could tell I would soon be in a nursing home, despite being only 57 years old.

The exam room door opened, and my doctor greeted me with a big smile. “I’m glad to see you’re doing so well. Your test results are exactly where they should be.”  Stunned, I blurted out, “Then why do I feel like I’m dying?” 

Clearly the test results were not reflective of my condition. Alone, they are not enough. They are only one source of information. That’s all. They must be considered in the context of the person’s reported condition—how they feel—and interpreted as a whole.

How did we come under the tyranny of the test?

We’re seeing the effect of a perfect storm in which technology has brought us myriad testing possibilities at a time when doctors are faced with more litigious patients than ever before. It’s not surprising that they defer to tests and hide behind science.

The downside is that the art of medicine is being largely lost. Before we had all these sophisticated tests, doctors drew on a combination of their training and intuition to make decisions. This was the art of practicing medicine. Both they and their patients knew they were doing their best with the resources at hand.

But this dysfunctional state of affairs isn’t just on the doctors. We patients have made doctors responsible for our health. We have willingly bought into the cultural myth that it takes external “expertise” to determine what’s right for us. We have given up our intuition and common sense. The payoff for us is that this leaves the door open to blame the doctor if things don’t work out.

Abracadabra!

Magic Wand

image via FairyDustDecals

If I could wave a magic wand, I’d restore doctors’ confidence in their ability to practice the art of medicine. Then they could be as effective as they imagined when they were young and hopeful.

And for patients, I’d reinstate trust in their innate knowing about what’s going on in their bodies and what will move them to a healthier state. That way, they’ll no longer need a scapegoat for their healthcare decisions.

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