Investigation Vs clinical skills.

[DuXcK]

to make it simple:

1) as a patient, will u trust the clinical skills of the doctor more or the lab investigations more ? Any perticular reason ?

2) as a doctor, would u trust ur skills and make a diagnoses and the following management plan or u will try to order as much investigation as possible b4 taking any more ?

3) Is it cost affective to order many investigations ? more over, do they really make a difference ?

[VANQUISH]

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<b><i>DuXck said:</i></b>

1) as a patient, will u trust the clinical skills of the doctor more or the lab investigations more ? Any perticular reason ?

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I weight them on the same level...both r subject to human error..



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<b><i>DuXck said:</i></b>

3) Is it cost affective to order many investigations ? more over, do they really make a difference ?

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If it's a critical matter..it sure is...

[LastAmeriGent]

I suspect both until I can prove them correct and reliable. My wife is a cancer survivor, thus the past two years have been quite challenging for us. Surgeon was very good regarding the tumor itself, but was not very knowledgable about Lymphedema that resulted from his surgery. Chemo Oncologist was pretty much a jerk, but worked as a team with the good surgeon. We switched to another, mid stream. Finally, had we not spent many hours online researching, we would not have been able to ask the questions we did, and even correct a few things that were not being treated properly.

My best advice: Do your homework (research) and don't be afraid to change doctors if anything at all does not "feel" right.

[gabby]

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1) as a patient, will u trust the clinical skills of the doctor more or the lab investigations more ? Any perticular reason ?


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Sometimes it is necessary for Lab diagnosis to pinpoint what is actually happening.
Vanqish and LAG brought up some good points. Both are subject to human error and to shop around.
When I had gallstones. The first Doctor I saw said it was indigegestion gave me some tablets and sent me on my way without follow up.
The second doctor was unsure, but said it is quite possibly gallstones, ordered lab tests and an ultrasound and sure enough there were six large stones there.

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3) Is it cost affective to order many investigations ? more over, do they really make a difference ?

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Depends on where you live and what kind of medical benefits the country has. At my lab if four or more tests are ordered then anything after four ( I am assuming the cheaper tests) are free. Most of the tests are covered by medicare.
Sometimes it does make a difference ordering many tests. Sometimes it doesn't. It depends on what is wrong with the patient or what kinds of risk categories the patient falls into.

[LastAmeriGent]

Good points, Brat. I hate our form of managed health care and insurance because often the tests won't be covered and Doctor's and lab staff's hands are tied!

[DuXcK]

Relying on the tests or the clinical skills ?

If you are to choose, then, will u choose the doctor who has access to the best and most advanced investigations (including CT, MRI..etc) or the person who can diagnose your problem with his clinical skills and confirm the diagnoses with some simple non-expensive tests ?

In the case of a gall stone, we diagnose gallstones based on our clinical skills not the investigations.

At the most, we might order an ultrasound of the liver and gall bladder to confirm the location of the stones as a pre-op investigation.

In the U.S doctors are good in ordering investigations and making the plan of management according to these.

When i was working in the american university hospital in Beirut, I was shocked of how the senior doctors examine their patients !

a doctor who has good clinical skills can save u lods of pain and money.

I'll mention a small story here that happened sometime ago.

a 20 years old unmarried girl came to me with 3 months history of missing her periods, vomiting and anorexia. She lost around 5 kgm of her weight.

I examined the abdomen and ordred 500 bzs worth of test and got the diagnoses.

Before coming to us, she has CT brain, Full hormone essays, Endocopy, Full blood cell counts, Liver function tests, Kidney function tests, X-ray abdomen, X-ray chest, Barium swallow and follow through, Blood urea and electrolytes..etc etc

All of these tests costed more then 500 rials + alot of exposure to radiation and pain !

All of the above to discover the diagnose with only one test and proper clinical examination !

[Julieanne]

So,,, What was wrong with her???

And why didnt the other tests, doctors pick it up?

[Jimrid]

As a matter of convenience most laboratory test request forms are "tick the box". They contain a list of tests and the doctor ticks the tests that he requires.

All too often many doctors ( and nurses )will tick every box because it is easy and convenient and covers all possibilities, irrespective of whether the requested investigation is justified or not.

This kind of approach to Laboratory Medicine enables the doctor ( or nurse ) to cover up any deficiencies in training or skills that they might lack.

Doctors should first use the medical history and clinical examination of the patient to get a tentative diagnosis and then confirm their diagnosis by selective laboratory ( and other paramedical )investigations.

Clinical skills are the primary approach when examining a patient and follow up investigations are a necessary but important secondary approach to confirm the findings brought about by a thorough clinical examination of the patient.

[gabby]

There are doctors then there are quacks. Shop around.

Many times I have seen in the clinical notes "tiredness" and 10 or more blood tests ordered (some unnecessary). Maybe the person needs more sleep.

We have a regular doctor who orders Pregnancy tests for all her female patients. From 12 to 60 yr olds. Not necessary.

[DuXcK]

In our health system, everything is provided to the omani citizens at no charges. Everything is free.

I feel that the abuse of ivestigations and tests are due to the availability of the services and no accountability about the usefulness of what has been ordred.

Lets take the doctor who orders the pregnancy test for every1, if the patient is paying for the test, then, she wont pay to get the pregnancy test done on her 13 years old doughter while all what she complains about is some milt urinary tract infection, right ?

Is there any other reason behind the tendency to abuse the investigations ?

Another reason I thought about is what some members said here. Many doctors lack the necessory clinical and communication skills, therefore, they try to cover that with the investigations they order.

[Jimrid]

Nothing is free as there is always a cost somewhere and it might not necessarily be money........whilst the patient does not pay for the test, the cost of the test comes out of the laboratory budget. Many of these tests are expensive.



Performing unecessary tests wastes time and resources that may be better spent on tests that are necessary and of benefit to the patient. It increases the workload on the staff and may result in mistakes if staff work under too much pressure. It also increases the time that you have to wait for the results.



Using up your reagents unecessarily means that when the time comes for you to perform the same test when it is really necessary....the cupboard is bare and the patient loses out !!



Doctors should not be allowed to order tests unless they know what they are ordering. If they are not sure what to order, call the lab and discuss it with a laboratory staff member who is medically qualified. It is better to do this than waste valuable time and money.

[gabby]

"Performing unecessary tests wastes time and resources that may be better spent on tests that are necessary and of benefit to the patient. It increases the workload on the staff and may result in mistakes if staff work under too much pressure. It also increases the time that you have to wait for the results."

I agree wholeheartedly with that <img src="/threads/images/graemlins/smile.gif" alt="" /> having just come home from a busy night at the lab.

"Doctors should not be allowed to order tests unless they know what they are ordering. If they are not sure what to order, call the lab and discuss it with a professional.....or maybe that would mean losing too much face !!!"

This is a problem that we face on a daily basis. No offence to the doctors in this forum. When we talk to a doctor about certain tests, some don't really understand that there are certain requirements for a test or that they incorrectly collected a sample. We have to watch what we say or else we may come across as condesending, which apparently some doctors hate <img src="/threads/images/graemlins/smile.gif" alt="" />

[gabby]

"Is there any other reason behind the tendency to abuse the investigations ?"

At one stage in Australia some doctors were paid off for using a particular lab. I believe they have cracked down on this.
I know with some of our doctors that if 10 or more histology samples come in for one patient they, the doctor, are paid an extra $500.

[muscatplatypus]

From what I have seen, many times the patients arrive expecting a barrage of tests. They insist on having procedures like Xrays, blood tests etc. despite a doctor explaining that they are not necessary. Should the doctor not prescribe what the patient thinks he should have, it ends up in a big argument, with the patient going to administration to complain. This I have seen many, many times.

Many patients are unrealistic about their treatment also. If you are started on antibiotics for an infection, the infection will not clear up in 24 hours - it will take at least 48 hours for them to start to work.

I agree that patient education is the way forward - for example, if you have a 3 hour history of a fever and are usually fit and healthy, then take some Paracetamol 4-6 hourly and go to bed. Is it really necessary to visit an AE Department?
Ladies, period pains are uncomfortable, but they will not kill you. Take some painkillers and move about - a visit to a hospital will not cure it.

I would value a proper physical examination way over a doctor just prescribing a barrage of tests for me to go through. What good is a CT Scan if the doctor hasn't noticed the patient isn't breathing??