Medical check up: battery of exams does not replace clinical analysis
View the scenario: the patient enters the office and says "Doctor, I'm fine. I just came to a checkup and wanted to do all the exams that are there", or, the patient does nothing requests, but receives a standard request of 40 exams. Has it ever happened to you? The question here is: do these exams really improve the quantity and quality of life? My opinion is that the exact opposite occurs and to understand why, let us see how the doctor reasons.
How the doctor thinks
The first action of a doctor when receiving a patient is to ask their complaint and try, through history and physical examination, understand the origin of this. At the end of the procedures, he has most likely already aligned several diagnostic hypotheses with the task of testing them in descending order of probability, until one is proved correct. It is at this point that the examination enters as the instrument used to help confirm or rule out a hypothesis - and it is only in that context that it has meaning or relevance. When the doctor asks for an exam, he already knows which set of results would affirm or deny his suspicions. Consequently, tests dissociated from a hypothesis are uninterpretable, non-informative and dangerous.
But why dangerous?
Out of 40 examinations, some are unavoidable. However, altered exams do not necessarily reflect the presence of disease. It is up to the physician to make the connection in the context of his diagnostic hypothesis. At the same time, as inexplicable as this change is, it is very difficult for the doctor to ignore it. Thus, the examination will not only consume a significant portion of the physician's attention, but will also divert clinical reasoning in an unproductive direction, motivating further examinations to try to explain the inexplicable and irrelevant. These, in turn, will indicate more deviations, perpetuating a confusion that delays and hinders the correct diagnosis.
But is not it the more exams, the more secure I am?
The essence of good health is the regular practice of good habits, and the essence of diagnosis is history and physical examination. Base your health on exams would be to do as the joke says that to ensure your safety, you must carry the bomb itself, because the chance of having two bombs on the same flight is insignificant. It is an illusion of safety that can harm you, because altered exams produce more exams and procedures that will expose you to unnecessary and undesirable risks and complications.
This is why your role as a good patient is to choose your trusted physician, someone with whom you can openly dialogue, whose attitudes make sense and let you work. And the doctor's role is always to remember the phrase that his masters both hammered during his training: "The clinic is always sovereign, so treat the patient, not the exam." Any other approach is to take a shortcut to hell.
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