Wednesday, September 17, 2008

Blood Tests: Bloody Tests!



Would Rosalind ever confirm or exclude her thallasemic state in life? In future, will she end up marrying a fellow thallasemic carrier and give birth to babies with full-fledged thallasemia? Will the young lady blame God and fate and doctors and genetically-modified food should that ever happen? Will she protest in denial that she is well and fine and healthy and unblemished because a packaged blood test bask when...



Blood Tests: Bloody Tests.


This is going be somewhat of a rant.

A middle-aged father stormed into the consultation room demanding urgent blood tests for his 14-year-old daughter, Rosalind. Earlier, this Mr Chong had been pestering the clinic staff to hurry me up as I was spending some time counseling an elderly lady on her medications for diabetes and hypertension. When I finally met the father and daughter, he was less than friendly and not in any mood to exchange greetings. He demanded immediate blood taking. When I asked exactly what blood tests he had in mind, he folded his arms across his chest and remarked in a barking manner that he wants the “whole package”.

I noticed that Rosalind was clearly pale and was wondering if she had some underlying chronic illness.

I started to enquire about risk factors for anemia, trying to elicit the possible underlying cause(s). Instead of answering my question, Mr Chong brushed off my suspicions of anemia and attributed the apparent pale state of her daughter to prolonged fasting the night before and supposedly worsened by my consultation with the patient prior to them.

“No, my Rosalind is not pale. She had fasted since 12 am and of course she would appear pale. We were waiting for a long time outside while you were attending to the other patient. Just do the blood test.”

At this juncture, I was becoming irritated and less than amused. I had earlier intended to educate and advise against unnecessary blood tests in view that she was a young person with no known medical illnesses. Mr Chong as the father and self-appointed spokesman was uncooperative in answering pertinent questions regarding her daughter’s health, preferring instead to believe in his self-constructed delusions.

In addition, Rosalind was obviously less than enthusiastic over a blood test that she felt was unneeded.

The blood taking was anything but easy. An anxious young lady and fine veins were not exactly a fine combination. She complained of feeling dizzy soon after the needle prick. Rosalind ended up with a syncopal attack which lent more ground to the father to blame “prolonged fasting”.

The unpleasant episode did not end there though. Instead of feeling remorse forcing his daughter through a painful procedure, the father snapped at the young lady for being overly anxious.

Before they exited the consultation room, I mentioned that a pale-looking young lady is not normal and asked for a family history of thalassemia. The father replied in the affirmative but was seemingly never told that it was possible for her daughter to inherit the defective gene.

She had never been screened for thallasemia. She also just recently had her menses. For that reason, Rosalind was probably more anemic than her usual days which was most probably why she was so pale on the day I saw her.

Would Rosalind ever confirm or exclude her thallasemic state in life? In future, will she end up marrying a fellow thallasemic carrier and give birth to babies with full-fledged thallasemia? Will the young lady blame God and fate and doctors and genetically-modified food should that ever happen? Will she protest in denial that she is well and fine and healthy and unblemished because a packaged blood test bask when she was age 14 proclaimed her in the pink of health save for a low hemoglobin attributed to menses and hookworms? Will she ever discover that it was her overzealous and obstinate father that effectively prevented a well-meaning doctor from pursuing the right and relevant laboratory tests for her?

I am sometimes tempted to merely do the minimal for patients who come in demanding the “usual package” of blood tests. After all, I have nothing to lose and little to gain. It’s not my clinic, merely a locum station. I earn nothing apart from a set rate per hour. In fact, the less I talk and counsel, the less work I need to do per hour.

The only question at the back of my mind is a matter of conscience. Is it right for me to be a part of the great conspiracy misleading patients into putting their faith in tests rather than clinical acumen?

A “package of blood tests” can easily set one back by over RM 200. Most tests are totally irrelevant and unnecessary to begin with. A ‘patient’ volunteering to undergo a cocktail of blood test is more likely to have good health-seeking behaviour as opposed to a chronic smoker/alcoholic who insists that he is fine and well and refuses all forms of investigations.

No sane person would enjoy and jump for joy at the thought of a blood taking on oneself except maybe the friendly neighbourhood masochist. As a doctor, I have been trained not to imposed unnecessary pain and especially more so when the patient is a helpless child whose only reason to be at the clinic is because of a father dictating so with an iron fist.

Blood tests are never a substitute for a complete medical history and a thorough medical examination. Blood tests and for that matter, any sort of laboratory investigation, are never a hundred percent specific and sensitive. A normal report does not mean one is free from illness and an abnormal one does not make a person diseased. Laboratory tests can be downright misleading, especially more so in the way unethical laboratories are marketing them to be.

The so-called ‘tumor markers’ deserve a special mention of course. At an age where everybody is afraid of suffering and dying from cancer, laboratories bank on people’s phobia and vicariously proclaim in such a way that tumor markers are a reliable screening test for an occult cancer. The truth cannot be further from that.

‘Abnormal’ reports usually lead to more tests, and more anxiety, and more wastages of hard-earned money. In the end, more often than not, it turns out to be a human oversight, sampling error, mixed-up reports or some unexplained mysterious phenomenon.

Will there ever be an end of the beginning of some regulation over these overrated laboratory services?

Will the Malaysian Medical Council (MMC) look into laboratories’ making exaggerated claims of being able to screen for cancer and ‘18 serious medical illnesses’?

Oh, I forgot – the MMC is too busy measuring doctors’ offices and putting them in jail and through humiliating search exercises. Its present Director General, a politician-wannabe is of course, trying to save the PM’s ass in a prominent asshole case.

Pity the Malaysian patients….

2 comments:

koolgeek said...

we need a better health care system for sure. one that guarantee public's access to affordable professional medicare and ensure practitioners' benefits.

ChottoMatteKudasai said...

Dear Dr,
I quite curious what actually happen to the little girl. Would you mind to tell more?