Blog | Tuesday, March 15, 2016

Test responsibly

I got a heads up the other day that our organization had been dissed by a CNN reporter who was frustrated by her inability to get tested for Zika. You can read her original piece and the follow-up here. Short version is that she was upset that it was difficult for her to get tested after returning from a vacation to Costa Rica where she encountered “a good amount of mosquitoes” and later developed a mild febrile illness.

I won't defend that she was made to feel like she was getting the run around, and it seems like at the very least we could have done a better job of communicating with her. But what she seems to dismiss, even though it goes to the core of her encounters with all of the medical providers she contacted, is whether she should have been tested at all.

Sorry, but “I have insurance and was willing to pay” and “I just wanted to know for sure” fall well short of appropriate indications for any medical test. Responsible testing involves engaging a patient in a discussion about the clinical circumstances, the reliability of testing, and the likelihood of the results having an impact on management. Isn't that why medical testing requires a physician's order?

I am not saying that patient preference has no role in testing. I have had plenty of conversations with patients over the years, for example, about the utility of measuring lipid subfractions or performing coronary artery calcium scoring to refine individual cardiovascular risk assessments. No 2 of those conversations were ever the same, because they were influenced by lots of patient-specific circumstances: their tolerance for uncertainty, their sense of self as “well” or “sick,” and their willingness to undertake an intervention such as lifestyle modifications or medications, to name just a few. But I grounded every 1 of those conversations with the questions like “What are we going to do with the information” and “How would doing this test change how you feel or act”? Ordering tests because patients are “insured and curious” is irresponsible.

Those considerations seem to have been completely absent in the case at hand. Ms. Kosik concluded her article by saying that it is a “bitter irony” that she never got tested for Zika, and may have instead exposed herself to other pathogens waiting in ERs to get tested. To me, the irony is that she didn't recognize that she was complaining about not getting a test she had no reason to get.

What do you think?