Medical management - 17 Nov 2008

In today's newsletter there is an item that suggests that actually listening to patients and them examining them carefully may provide more information on the condition of their cardiovascular systems that putting them on a treadmill and looking at their ECG. The study showed that the predictive value of the exercise stress test - in the participants in the study - was no better than a good history and examination. In other words - clinical skills.

This is, to me, an important study. It shows that a well trained and conscientious doctor is at least as useful as a series of expensive investigations. I am sure that exercise stress testing is not the only investigation that may be less useful than people think.

There is an increasing tendency among doctors to go for investigations - at great cost to the patient and their medical schemes - simply because they are available. And, unfortunately patients have latched onto this to such an extent that extensive investigations are regarded as the norm.

My 86-year-old father-in-law is a case in point. An unnecessary admission to hospital resulted in a series of investigations that showed that he has a particular heart condition that can only be treated by surgery - something for which he is not a suitable candidate. The cardiologist suspected the specific condition after a clinical examination and an echocardiogram (a relatively inexpensive and non-invasive investigation) and went ahead and confirmed it by doing a CT scan - expensive and very uncomfortable for the old man. Given my father-in-law's general poor health, the CT scan should probably not have been done. It didn't change the old man's management in any way and has left him fearful of the consequences of his condition and of any future admissions to hospital.

An investigation is only useful if it is going to change management - keep that in mind when you visit your doctor.