Friday, 10 April 2015


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.


  1. Dr. Keren this was insightful. What occurs to me is that the way to go for Nigeria regarding public health policy is likely to be a heavy dose of preventive medicine and patient education. Given that a large segment of the population in rural areas may not even have access to medical care. This policy along with insuring safe drinking water might be the most practical way to prevent disease, save lives, save money and reduce the heavy burden being carried by dedicated physicians like yourself.

  2. I think I agree with you on a happy medium. There should be experience and knowledge behind any testing. But, experience and knowledge might not come up withe right answer every time, so taking if there is a doubt I think they should run more tests. Great post!

    You can find me here:

    1. Tests are good, they help to determine a lot. However, running plenty unnecessary tests may not tell you what's wrong with the patient and it ultimately doesn't help the pocket much. For instance, when Ebola hit Nigeria, the 1st contact doctors were able to get it right because they had a high index of suspicion. If they didn't, the man could easily have been passed off as dying from complicated malaria.

  3. This was a great intriguing post! I am all for tests because through then you can see what is really there and discover things your probably didn't know where! Great to meet you through the challenge!

    1. Nice to meet you too Tammy, thanks for commenting

  4. Sometimes tests aren't enough. I went through a bunch of tests once because of pain and no doctor knew what was going on. One was firm (and rather mean about it) that it wasn't my gallbladder because the tests were negative. I spoke to a surgeon instead and he said, based off what I'm telling him, it was my gallbladder. I had to removed and tada! No pain anymore.

    1. What an experience! Thank God you met a good surgeon that used his brain. Tests were made by man to help with diagnosis, not to think for man. Like my teachers always say, "treat the person, not the results".


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