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Diagnostic tests; when are they needed

Diagnostic tests: when are they needed?

Laboratory tests in children are often not necessary

In the private health sector, we often hear about insurance packages offering unlimited laboratory tests. Is this justified for your child’s health?  In a word: No.

What happens when the doctor prescribes laboratory tests?

Every test performed on a child, blood, urine, x-ray or other, has three possible outcomes:

  1. It is positive, therefore providing information for the doctor about a disease
  2. It is negative, therefore helping the doctor exclude a disease
  3. It is ambiguous, therefore difficult to interpret, resulting in the need for repetition or for other tests.

When, for example, a urine test is performed using a urine bag, there is a significant possibility of finding a small growth of mixed bacteria, requiring repetition of the test, or obtaining urine by using a catheter.

Therefore, doctors need to be certain that any test they prescribe is absolutely necessary. They should also be experienced enough to interpret the results correctly.

What’s wrong with too many laboratory tests?

  1. Risks from the test itself. For example, a CT scan exposes a person to a high dose of radiation. Adult patients getting precautionary CT scans of their entire body has even been heard of! It is obvious that the paediatrician should be absolutely certain that a CT scan is necessary for a child.
  2. Procedural problems of the test. Every test performed on a child more than likely:
  • Is painful for the child
  • Is stressful for parents
  • Disturbs the child’s routine
  • Is responsible for loss of school hours and working hours for parents
  • Entails financial cost for the family
  • Entails financial cost for insurance companies and society in general

Your toddler comes out in a rash. His clinical image for an experienced paediatrician is reassuring. The cause is one of the thousands of viruses being around. If another paediatrician causes anxiety to the parents, by requesting that the cause be found by doing sophisticated blood tests, all of the above will be experienced, only to diagnose something insignificant, and the diagnosis will not change the child’s treatment and prognosis.

Risk of over-diagnosis and over-treatment.

Every time a doctor in doubt prescribes an excessive number of tests, the result is excessive medical intervention and administration of medications.

For example, if a two-year old boy with a runny nose and a cough undergoes an unnecessary chest x-ray, there is a greater than 10% chance of discovering mild, viral pneumonia. The child has a virus that will not respond to antibiotics, and will pass by itself within a few days. However, the x-ray will result in the common practice of the child being hospitalised and being given antibiotics intravenously. This means unnecessary pain, discomfort, loss of working hours, financial expense, possible sleep and behaviour problems for the child after hospitalisation, side effects from the antibiotics, and an increased likelihood of hospitalisation in the future ( causing stress to the parents and doctor due to the previous episode).  A chain of harmful medicalisation of events, which began the moment an uncertain paediatrician requested an x-ray for a runny nose.

Children need to be protected from the vicious circle of unneeded tests, medications, and hospitals. Parents can protect their little ones by choosing a paediatrician with solid clinical foundation and experience, who puts the child’s interests above financial interests.

Stelios Papaventsis Paediatrician MRCPCH DCH IBCLC 2012

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