Okay, it's time for my atozchallenge post for today and I is for Investigating the patient. I'll start with a story;
Once upon a time, a man fell ill and ran to the nearest laboratory to get tested. Since he wasn’t science oriented, he allowed the “lab scientist” run a test on him. At the end of the day, he was told he had ESR – erythrocyte sedimentation rate. These lab scientist administered treatment in the form of intravenous fluid with vitamin B-complex in it. After that, he paid N5000 and went home. When he didn’t get better after 3 days, he was in the hospital with this tale. I don’t know how I managed to hold my laughter. My laughter was caused by the fact that ESR is not a disease, it is a test!
In Nigeria, (don’t know about other countries) when people fall sick, they tend to follow 3 major pathways;
- the ones who seek care in the patent drug stores like I have elaborated here,
- the ones who go to the laboratories (within or outside the hospital premises) and,
- the ones who go to see the doctor for consultation and expert advice.
Of the above named groups, the first takes the chunk of the patient load (surprising eh!), while the third has the least, until the people in the 1st two groups develop complications or aren’t getting any better then, the equation slightly reverses. Today however, I’d like to take a look at the fraction that seek out laboratories and tests before consulting a doctor if ever they do.
Over the years, I have seen several patients who ask this one question after the consultation and are asked to go home on just medication. That question is “Ah ah, doctor! No test?” Many times I have also seen some who come and when asked; “how may I help you?” They reply; “doctor I did some lab tests, and here are the results.” Usually, I have to take a deep breath, collect the results, keep it on my desk and repeat my question. I do this to avoid any form of bias. To be able to effectively treat the person and not the paper (that might have wrong results by the way – anything happens in naija). The worst I’ve seen so far till date are the patients that go to some chemist shops or labs and stand on a machine that pretty much like a weighing scale to me, others are told to hold on to something. These devices, they say are from China (no offense), and they are able to tell a person the type of illness they are suffering from without drawing blood or urine or any specimen for that matter. It doesn’t matter if you were fit as a fiddle before you got on the machine; you just have to have a diagnosis allocated to you. Lol.
It finally hit me that this group of people placed more emphasis on getting a diagnosis from lab tests than from actually visiting a well trained doctor who can marry symptoms and signs and determine the necessary investigations. There are 2 schools of tort on the use of investigations for patients (at least that’s what we are being told), the American school that says, run a barrage of tests to find the cause and treat. The British school that says, take a good history, examine and make a diagnosis, then investigate along the pathway. For me, I think moderation is key, as always. To be able to differentiate between the patients who require a lot of tests, few or none at all. Because, in a resource poor country like Nigeria, it would be useless to a patient, to have plenty test results and no money left to obtain the required medications for treatment.
I would love to know how you really feel about doing investigations/tests.
A little fact: In many developed countries, the use of investigations/tests in medicine has been for a very long time (couldn’t find a particular date).This is not the case in Nigeria. I just found out from one of Ben Carson’s books that while they already had ultrasound scans in the USA in the 80’s, I did hear of one until 2005 and didn’t see one until much later. The CT scan and MRIs we hear of today and are still struggling to get (fairly used ones for that matter) into our federal hospitals have been since the 90’s if not longer.