More Medical Testing, More Problems
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“So, Dr. Pelzman, what should I do about all these test results?”
This seems to be a portal message many of us have received with increasing frequency over the past year or two, as patients are finding more and more ways to get tests done. Often these are completed at stand-up laboratories, via online portals, or in walk-in clinics, where patients have little interaction with healthcare providers and are just given a menu of things to check for. Sometimes they are done with fancy longevity practices and wellness clinics that have no intention of being involved with the patients for the long haul.
Patients tell me they are checking on hormones, memory problems, fatigue, inflammation, cognitive decline, sexual health issues, immune deficiencies, and sleep disorders.
One of my patients recently sent me a PDF of 14 pages of labs that had been completed, with a note attached that said, “Speak to your PCP about these results and next steps you may want to take.”
So, Dr. Pelzman, what should I do about all these results?
One of my reflex responses to this type of portal question is usually, well, did the doctor who ordered these tests tell you what they mean and what you are supposed to do about them?
Often, they say, “They told me to ask you.” Or, “I never spoke to a doctor, it was just a place where we were allowed to get these tests done.”
For a hefty fee, of course…
When I look through some of these tests, I often don’t know what they are, don’t know what they are testing for, and would never think of ordering them on a patient. Nor do I usually (ever?) know what to do with the results.
Time for a quick artificial intelligence (AI) internet search…
When I see the advice attached to these massive lists of tests, they include things like: eat a healthy diet, keep well hydrated, avoid stress, get plenty of sleep, exercise regularly, do things to keep your mind engaged, form social connections, prevent falls.
This sounds a lot like the advice I give my patients, often before I order any tests at all. And I definitely don’t prescribe dozens of expensive proprietary supplements of unknown clinical value to go along with these tests.
I remember in medical school, when we first came to a place of ordering labs, someone told me: don’t order a test that you don’t want to know the result of, or the patient doesn’t want to know the result of, or you don’t know what to do with the result of it when you get it. Another wise teacher also told me that if you order enough tests, something’s going to be abnormal; that’s the way statistics work.
For years we battled with the conundrum of getting “routine labs” on patients. Whether these make sense on an evidence basis or not, our patients tend to expect them and want them.
Sometimes during a routine visit, I’ll determine that I didn’t need to do any more tests on the patient; their test results had been normal in the past and nothing had changed. But then I’ve heard that they went home and their significant other said, why didn’t Dr. Pelzman get blood tests on you today?
Now, when someone sends us a massive list of test results to interpret, it appears they expect us to turn this into a primary care consultation, for us to render a medical opinion and offer suggestions, tacked onto another visit.
But in these days when primary care doctors are burned out and overburdened, we should insist on being compensated for our intellectual effort, our time, the cognitive work to figure stuff out for the people out there who didn’t want to do the heavy lifting. They just wanted to test, test, test.
Maybe someday we’ll just be able to sick the AI agents on it, to run through all the test results, tell us what they mean, what they might mean for the patient, and what we could do next.
If you order enough tests, you’re going to generate enough issues and problems and questions, and you can never have enough time to fully explain everything to everybody’s satisfaction.
This is how we primary care doctors feel when patients come in for their 20-minute appointments with a laundry list of issues they want to discuss, and then they’re frustrated when they are referred out to a neurologist for their headaches, a gastroenterologist for their reflux, an endocrinologist for their osteoporosis, a cardiologist for their arrhythmia, and a pulmonologist for their chronic cough.
We all wish we had all the time in the world to put into the care of our patients. With the demands on us to shove more and more patients into a day’s schedule, it’s no wonder we often feel like we’re just trying to stay afloat. We need to find a way to get all our patients all the care they need, right when they need it, without resorting to just ordering a boatload of tests, especially ones that no one really wants the answer to.
Because if you do run all these tests, be prepared to tell the patient what comes next.
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