The control of investigations rivals the prescription pad as a doctor’s main tool of power and control.
We have become seduced into thinking that it is an accurate gauge of illness and even serves to make a diagnosis.
In both cases this is not necessarily true.
What this caption highlights is the art of medicine. It also foreshadows the paradigm shift that will occur in health by outlining its features and our need to attend to them.
A medical diagnosis is made from taking a history; that is, listening to their story.
By this time the practitioner should have a fair idea of the diagnosis, and an examination may confirm this, raise other issues that were not in the history, or lead to another conclusion.
Investigations can be used for confirmation and quantification. They are also useful in monitoring ongoing progress of management.
But investigations like a raised blood sugar or cholesterol level do NOT point to a diagnosis of diabetes or heart disease.
So treating these tests AS IF they do, or may lead to these problems, is erroneous.
But it is a mistake easily fallen into, and leads to the prescription pad – and the pharmaceutical industry’s hip pocket.
Investigations should confirm and support a clinical diagnosis, but not be used to make one.
There are many instances of not only unnecessary medical management, but also needless surgery that can result from this simple fact.
Also be aware of the myriad other forms of investigations that have cropped up, such as saliva and hair analysis. These are useful additions to the health armoury, but should be seen in context.
The context is the clinical picture. What does it matter what the diagnosis is if you get better?
And if you follow the advice in the caption, most often you will!
The pathology and radiology investigation aspects of medicine have become big business; they are part of the Medical Industrial Complex.
As with other members of this Complex, financial returns are high on the agenda, so the more they are utilised the better.
And what is better than seducing the public into believing they are essential?
Take an example: the PSA blood for prostate cancer.
There are many false positive tests; that is, a high level when there is no cancer. Such issues as bike riding, or sexual activity can cause this (I bet your doctor didn’t tell you this).
Then, if high, you get probed and biopsied. If you are over middle age and certainly if elderly, there is a high chance you could have it anyway.
But you would probably die with it.
Instead you have painful management to consider, and may end up either incontinent or impotent – or both.
This example could be expanded upon, and I probably will at some stage, but maybe the point is made. Because there are many such examples.