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Which Test Should You Have? Go Where The Money Is ...

Timothy B. McCall, M.D.

When deciding which medical tests you need here are several things to keep in mind:

• Look for common conditions before rare ones. Common problems are common. Rare ones aren’t. The money says look for common problems first. Only if the search comes up empty, should rarer causes be sought. There are, of course, exceptions. In a emergency, as with an unconscious patient, a doctor may have to cast a wide net and look for many possible causes simultaneously. In general, however, things can be done in an ordered fashion.
• Avoid hunting for “zebras.” Some specialists have seen so many unusual cases in their careers that they tend to overestimate how common these problems are in the general public. When something comes along that looks like a horse and walks like a horse and smells like a horse, they think, “This could be a zebra!” Watch out when your doctor wants to order a lot of fancy tests to rule out a condition that almost nobody ever has.
• Rule Out Emergencies. The price for missing a diagnosis when someone in immediate danger of death or permanent harm can be immense. If a 60 year old man complains to his doctor of a heavy pain in his chest, his doctor may consider dozens of possible causes. It could be a pulled muscle, a bronchitis, a stomach ulcer or, as the man probably fears, a heart attack. The highest priority is to make sure it isn’t a heart attack, since any delay in diagnosis could prove fatal. By simply asking the man a few questions, the doctor may be able to determine that the pain isn’t coming from the heart. Sometimes the doctor will need to do an EKG. And, if suspicious enough, the doctor may admit the man to the hospital until it’s determined whether he’s suffered a heart attack. Once a heart attack has been ruled out, the search for other causes can begin.

Not all serious conditions, however, are emergencies. Only those conditions that if not treated promptly could lead to permanent disability or death need be ruled out before considering more likely diagnoses. Cancer is potentially life-threatening in the long-term but a delay of a few days in diagnosis is generally not critical. The same cannot be said of a heart attack. Even when cancer is a possibility, it is sometimes appropriate to wait a week or more to see if your symptoms subside, before proceeding to invasive tests.

Next: Making Sure You Get the Right Tests

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