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!
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