Know the Question

When you have a medical problem and are consulting a physician, is it more important to know the question or the answer?  If you are having any kind of test, should you be more interested in what the doc is looking for, or what they find? Not sure?  Ok, then let us play doctor:

            You are a working in the emergency room and you see a 50 year old

            woman who has stomach pain.  The CAT Scan shows no infection, no

            blockage and no mass.

             ANSWER THIS QUESTION:            Does the patient have?

             a.     ?????

             b.     ?????

             c.      ?????

             d.     ?????

 You could not complete this test.  Why?   Because, you have the answer (the CAT Scan result), but not the complete question.

When a physician sees a patient with a problem, the first step is to take a history and physical.  The doctor gathers information about what is going on. Next, the doctor makes a list of questions or possibilities about what is happening to the patient.  This is known as a differential diagnosis.  After creating this list, the doctor orders tests to determine which diagnosis is likely and which are excluded.  It is very important for patients to understand this multi-step process.  Differential first, then tests later.  However, in the day-to-day practice of medicine, at times events are rushed, and tests come first.  What can then happen are unnecessary tests, missed diagnoses and answers to questions which you did not even mean to ask.

The Prostatic Specific Antigen (PSA) blood test can detect prostate cancer at an early stage.  However, is this useful information in an 85-year-old man?  The CA-125 blood test is outstanding for monitoring patients with ovarian cancer, but used in healthy women, will be elevated more often in patients without cancer.  A breast MRI is probably the best screening test for breast cancer, but it also has the highest rate of false positives, resulting in unnecessary biopsies.  A CAT scan is a marvelous tool that can accurately detect hundreds of diseases, but it also can find things you might not need to know about (i.e. liver cysts, tiny lung spots, chronically congested sinuses, benign arthritis) and requires radiation exposure.

All these tests are very valuable, but if not used with care can lead to confusion. The patient and the doctor need to understand the questions and what is going to be done with the answers. This basic conversation allows the patient to prepare for the next steps and more importantly, understand the answers.

So, try again.  Let us play doctor:           

             You are a working in the emergency room and you see a 50 year old

            woman who has stomach pain.  The CAT Scan shows no infection, no

            blockage and no mass.

             ANSWER THIS QUESTION:            Does the patient have?

             a.     Appendicitis 

             b.     Small intestine obstruction

             c.      Pancreatic Cancer

             d.     Food Poisoning

 Final Clue – think bad clams.

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