One of the greatest advances in the 21st century has been none other than the internet. It has transformed every single aspect of our existence and more so in health. From basic transformations where patients can now go online and read more about their medical conditions to more complex ones such as remote robotic surgery.

Access to information has had very interesting impacts on the doctor-patient relationships and these will continue to evolve as time goes by. Doctors are continually prompted to read more about their specialties so as to be in the know as new drugs, technologies and diagnostics come up, even when they are still years away from being locally available. Patients now make better partners in their care as they get to embrace equal participation in decision-making.

The one part though that still has some way to go, is patients understanding diagnostics. Diagnostics are a very critical component of treatment. Laboratory and imaging tests are key in aiding diagnosis, monitoring treatment progress, monitoring toxicity, monitoring recovery and confirming cure. With all these functions, it is imperative that patients begin to acknowledge the importance of diagnostics and a basic understanding of the results and their relevance.

If I could have a shilling for every time a patient told me that the blood test done showed a bacterial infection in their blood…

This is the layman’s understanding of a full blood count (full hemogram). This is a very common and quite basic test done in patients presenting to hospital with almost every complaint. As translated, it basically says that the patient has bacteria in the bloodstream. Now bacteria in the bloodstream is actually a life-threatening condition called septicaemia that is fairly rare and has an exceedingly high mortality rate.

This displays how as practitioners, we have failed in helping our patients understand the relevance of the diagnostics we order on them. The only patients who seem to have some level of insight on the importance of these diagnostics are patients with chronic conditions on long-term follow-up. These include patients suffering from cancers who will understand tumor markers, size of mass and white cell counts; HIV patients on anti-retrovirals who fiercely protect their CD4 counts and viral loads; diabetics who care about their blood sugar level among others.

For acute conditions like malaria, pneumonia, sore throats, colds and flu and urinary tract infections, tests serve three main functions. First, the tests confirm diagnosis such as a malaria slide for microscopy to show the parasite or a chest x-ray to show lung consolidation in pneumonia. The tests can also be used to reflect severity. In this case, a full blood count showing a very high level of white cell counts tells that the body is in overdrive to try and contain the infection irrespective of where it is and hence explaining the high fevers; or a urine analysis that shows a high number of pus cells indicating a more severe infection. Finally, repeating the same test at intervals helps to demonstrate that the body is responding to treatment, hence in malaria, if the density of the malaria parasite is decreasing with treatment, then it means the drug used is working.

In Kenya, we do not have a centralised patient record system. If a patient is seen at the same hospital or clinic, their care is documented in the file or online record. Once the patient changes hospitals or clinic, the doctor is taken back to zero. The patient won’t come with a record showing what has been done so far and what the diagnostic findings have been so far. Because of this, many tests are repeated unnecessarily and critical information is lost.

For this reason, it is important for patients to wizen up and always keep a copy of all lab reports and imaging records. It helps to have a personal medical file at home where one stores all these results among other medical records such as discharge summaries from previous admissions, vaccination records and even copies of prescriptions given out over time. This is the first step towards the patient getting more involved in their care.

It also helps to have your doctor explain each test being ordered, why it is being ordered and how it influences the decision-making process in your care. Sometimes, tests may be ordered for documentation of your status at the first contact with your doctor. These allow for future reference in case the situation changes. This is common in instances such as HIV exposure (such as a needle prick) where one’s liver function tests and kidney function tests are taken in healthy individuals prior to starting a 28-day course of anti-retrovirals to prevent one from developing HIV infection.

Another set of important tests are those ordered in apparently healthy individuals for purposes of screening for medical conditions. It is paramount that one understands that screening tests are not absolute. They are designed to be highly sensitive to picking out a potential problem. A negative result is hence a really good feedback. A positive result on the other end is not a 100% indication that one has the disease. Further confirmatory tests are required to ascertain the presence of the condition. Confirmatory tests are mostly expensive and possibly invasive and hence are reserved for those with a positive screening test. A lack of understanding the difference has been cited as one of the reasons some people fear going for screening tests especially in cases of cancer screening.

With our new-age access to medical information, I would like to urge patients to read up more on diagnostics and their role as they read on their conditions. Let us come together to dispel harmful myths. For instance, cancer patients who have already been diagnosed with stage four cancer in Kenya with less sophisticated tools, who spend so much money to travel to India for a Positron Emission Tomography Magnetic Resonance Imaging Scan, commonly known as the the PET-MRI or the PET scan, without realising it is just a sophisticated imaging method and not a treatment option!


 
Nbosire1

Nbosire1

Underneath the white coat is a woman, with a deep appreciation for the simple joys of life. Happy to share my experiences and musings with you through my work and life!

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