A tragic death is a reminder that unnecessary tests have the potential to cause harm
Between the end of my specialist oncology training and finding a proper job, I undertook a common rite of passage by earning an income as a locum doctor. A community practice was looking for a physician to supervise various forms of cardiac testing and welcomed my flexibility. A qualified technician did most of the work; my job was to ask brief questions and stand by for an emergency. I felt like the mundane attendant that I was paid to be.
One day, a pleasant middle-aged man arrived.
“Tell me why you’re here”, I began.
“No idea, love.”
At my frown, he added helpfully, “I guess my doctor would know.”
The referral had no clinical details. Probing the man’s history revealed no significant risk factor. Yet, he was there, eager to be done and return to work. I felt I had no choice in the matter.
After his uneventful test, he whistled and walked away, but even though I’d been only incidental in the decision-making chain, I nonetheless felt responsible. Every test had the potential to go wrong. Every test costs the taxpayer. Every test should have a clinical rationale.
I sought out the chief physician to broach the observation that a fraction of the tests I was supervising did not seem to have a clear clinical indication, hoping he would disprove me, but instead he was alarmed.
He was merely a service provider, he intoned. If he started to question the rationale for testing, he would alienate his customers, namely other doctors. I was deflated but with more experience, I might have predicted that sometimes, the most expedient solution to an ethical dilemma is to get rid of the person who thinks it a dilemma. That was the last shift I worked.
Nearly two decades later, my own heart skipped a beat when I read about the death of a woman following a cardiac screening test offered by her employer.
At the inquest into the mother-of-two’s death, the Coroners Court of Victoria heard that Peta Hickey was a 43-year-old senior executive with no cardiac history who underwent a CT angiogram, a test to detect coronary artery abnormalities, offered by her workplace in 2019 following a colleague’s near-fatal cardiac arrest. The workplace outsourced its corporate health program to a company that engaged another company. According to the inquest, Hickey was never assessed by a doctor including the one whose electronic signature was on the referral. The doctor told the coroner he didn’t add his signature to the paperwork.
The quest for improvement is real and urgent
On the day of her scan, the inquest heard that the radiologist could not contact the referring doctor to fill in the absent medical history. He proceeded with injecting the contrast dye, which induced an anaphylactic reaction. Eight days later, Ms Hickey died from multiorgan failure.
This unthinkable outcome yields salutary lessons for professionals and their patients. In this era of wellness, everyone wants an easy way to pre-empt disease and its consequences. A fitness trainer I spoke to could not understand my refusal to recommend a “head to toe” CT scan. After all, wasn’t it good to be safe? Yes, I replied: by coming off the energy drinks and anabolic steroids.
With the profusion of medical tests marketed as convenient and non-invasive, it is tempting to consider them as the alternative to the time-tested advice of eating, exercising and resting in moderation. It is difficult for many people to understand how anything labelled medical could be harmful to health, but there is abundant evidence that unnecessary tests have the potential to cause harm.
When South Korea introduced a national screening program for certain cancers, many providers tagged on a thyroid ultrasound for less than US$50 as part of a wellness check. Thyroid cancer diagnosis went up 15-fold in 20 years while mortality remained stable, according to a study in the New England Journal of Medicine. An estimated one third of adults harbour tiny thyroid papillary cancers that remain asymptomatic through life. But virtually everyone in South Korea who was incidentally diagnosed with thyroid cancer underwent major surgery or radioactive iodine treatment, each carrying the risk of serious complications. All it took to expose these unaware patients to the risk of harm was the offer of a cheap test.
This is why it’s so important for doctors to properly understand the benefits and hazards of a screening test before recommending it to patients.
To this end, cancer researchers including some Australians, deserve credit for communicating their disappointment with results of a three-decade long study involving over 200,000 women, which found that ovarian cancer screening via a blood test and ultrasound led to early detection but no survival benefit.
Since ovarian cancer is almost always diagnosed at a late stage, and is associated with poor survival, the quest for improvement is real and urgent. But in language that the average patient can understand, the researchers explain that diagnosing ovarian cancer at an earlier stage does not change the point at which patients die because the cancer is inherently more aggressive. However, being seasoned researchers, they even-handedly point to the many recent advances in cancer treatment, including symptom management, targeted therapies and the promise of using evolving knowledge to build better screening tests and different trials. This is the language of professionalism, neither fuelling hype nor extinguishing hope. It is what every doctor should aspire to.
Patients have a right to expect information. One organisation, Choosing Wisely, has a list of five questions that every patient should commit to memory.
Do I need this test? What are the risks? Is there an alternative? What is the cost? What happens if I do nothing?
Reference: The Guardian: Ranjana Srivastava
No thoughts on “A tragic death is a reminder that unnecessary tests have the potential to cause harm”
Articles - Most Read
- Home
- LIVER DIS-EASE AND GALL BLADDER DIS-EASE
- Contacts
- African Wholistics - Medicines, Machines and Ignorance
- African Holistics - Seduced by Ignorance and Research
- African Wholistics -The Overlooked Revolution
- The Children of the Sun-3
- Kidney Stones-African Holistic Health
- PART ONE: DIS-EASE TREATMENT AND HEALTH-3
- 'Tortured' and shackled pupils freed from Nigerian Islamic school
- The Serpent and the RainBow-The Jaguar - 2
- PART ONE: DIS-EASE TREATMENT AND HEALTH-2
- PART ONE: DIS-EASE TREATMENT AND HEALTH-4
- PART ONE: DIS-EASE TREATMENT AND HEALTH-5
- King Leopold's Ghost - Introduction
- African Wholistics - Medicine
- Menopause
- PART ONE: DIS-EASE TREATMENT AND HEALTH-6
- The Mystery System
- The Black Pharaohs Nubian Pharaohs of Ancient Egypt
Who's On Line?
We have 127 guests and one member online
Ad Agency Remote
Articles - Latest
- Do Yams Have Carbohydrates?
- Cardiac-a-vest! Remarkable garment could save lives by predicting heart attack risk
- Inflammation-Busting Foods: A Review by Nutrition Professionals
- Dermatologist's insight on shower frequency without harming skin
- Meat is crucial for human health, scientists warn
- How dangerous are interactions between herbal medicines and prescribed drugs?
- The definitive guide to BMI, and how much you should really pay attention to it
- The nightly ritual that could improve memory and brain health, according to scientists
- Hyacinth Bean: How Nutritionists Rate Its Nutrients, Health Effects, And More
- Top healthiest fruits with anti-inflammatory properties
- Vitamin B12 deficiency symptoms: How to spot the signs in your feet
- Dehydration may be as bad 'as smoking' for veins - how much water you need to avoid stroke
- Winter Squash: A Superfood Or Not? Nutrition Professionals Weigh In, With Serving Tips And Health Risks
- Why The Nutrition Professionals Love Winter Melon, Nutritional Benefits And Serving Size Guidelines
- Lesser-known lung cancer symptom in arm or shoulder that can't be ignored
- HIV breakthrough as new technology removes all traces of virus from infected cells
- Seven fruits for diabetics to avoid that can increase blood sugar spike risk
- Top 7 Uses and Benefits of Dead Nettle Plants
- 6 physical symptoms of anxiety you shouldn’t ignore, according to experts