Questions Conscious selection

There is no established number of tests that a person should undergo, since we must always keep in mind that each one of us is unique and different. What is clear is that as we get older there are some functions of our body that we must evaluate more rigorously and according to our family and personal medical history, or according to our lifestyle, it is necessary to include some tests in a person or not. 

In Conscious Selection we seek to focus our strategies from the doubts or controversy that has been generated in the environment from the approach to a diagnosis, from prevention and wellness; tests that have become of common interest for doctors and patients and that we perceive that in the environment have led to controversy, overuse or lack of use due to ignorance or misinformation. The same diagnostic test can be a useful tool for physicians of different specialties and to study different diseases.

When a person has already been diagnosed with a condition or disease, medical guidelines indicate which tests should be requested from the patient for follow-up and control.

When a person seeks answers from a health professional because of certain symptoms or because he/she is interested in having a check-up in order to know his/her state of health and prevent complications, it must be established what risk factors the patient has for developing a disease, according to his/her age, gender, symptoms, personal and family medical history, and according to the findings found during the physical assessment; this guides the physician to determine which tests should be requested. Subsequently, taking into account the results, the health professional will make the decision to "stagger"; that is to say, to perform other complementary tests.

Otherwise, if tests of greater complexity or tests that do not match the patient's disease risk are ordered from the outset, errors such as these can occur:

- Obtaining unnecessary results that take away the interest as opposed to those that actually provide valuable information for the real diagnosis of the patient.

- Obtain results that, although outside the reference range, do not explain the patient's symptoms.

- Obtain information from tests whose results are still outside the reference range but do not represent a disease condition in the patient.

Currently, as patients, we have access to pages and texts with medical content in both technical and everyday language with the objective of informing the reader; however, it does not replace the medical interview, the physical assessment or the correlation that the health professional makes of this information in a medical consultation to finally decide what examinations and tests a person requires.

It is important to clarify that being healthy is not synonymous with being asymptomatic. This is why in a medical visit through conversation the physician will take into account the patient's age, personal history, family history, social and work environment, among others... and in correlation with the physical assessment will decide which tests are recommended to be performed on the patient even if he/she is asymptomatic. 

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Conscious selection

It is a space in which we want to share with the medical community and patients, strategies that allow us to make reasonable use of

Conscious selection is a space in which we want to share with the medical community and patients, strategies that allow a reasonable and optimized use of diagnostic and screening tests not only of clinical laboratory, but also of anatomical pathology, molecular and imaging tests. These strategies avoid the underuse and overuse of tests; that is, they seek to perform the correct tests on those who really need them and leave aside the performance of unnecessary tests on patients who do not require them.

Nowadays, access to information is simpler for everyone in relation to past times; this is how referral in health issues can occur through web search engines and social networks leading to misinformation of patients. Referrals can also be made through close people, friends or relatives; let us not forget that each patient is unique and must be seen individually in his context and his diagnosis arises after correlating symptoms, findings in the physical assessment and results of diagnostic aids. 

From the medical point of view, this is not an issue that generates controversy only in our environment; in the databases there are dozens of articles and related bibliography that reflect a worldwide problem since it has been seen that about 30% of tests ordered to patients are usually unnecessary and that diagnostic tests have an approximate impact between 60% and 70% in medical decisions.

It is better to think before you act:

  1. The clinical and epidemiological context of the patient in which risk category places him/her at risk for developing a certain disease?
  2. What are the tests, in order of priority, that allow assertive orientation towards the suspected diagnosis?  
  3. Will the complementary tests provide information that will help to define the treatment or change the behavior to be followed?

Conscious selection of diagnostic tests requires not only knowledge and expertise in their utility but also in their interpretation; otherwise they lead to a cycle of wasted time, expectations and money.

Patient well-being and safety come first.

References: 

  1. Baird G. The laboratory test utilization management toolbox. Biochem Med (Zagreb). 2014;24(2):223-34. doi: 10.11613/BM.2014.025. Epub 2014 Jun 15. PMID: 24969916; PMCID: PMC4083574.
  2. Huck A, Lewandrowski K. Utilization management in the clinical laboratory: an introduction and overview of the literature. Clin Chim Acta. 2014 Jan 1;427:111-7. doi: 10.1016/j.cca.2013.09.021. Epub 2013 Sep 28. PMID: 24080430.

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