Wieners and other cry babies and their diagnostic tests

Wieners and other cry babies and their diagnostic tests

Well this time I am writing about my favorite subject- criticizing anyone- but this time medical practice in TN (including fancy nonsense like sidha, homeopathy and all the pathies including Physiotherapy).

I am writing this after a TV program in TN (which fortunately I did not watch) which created a controversy and wieners in the medical profession are crying about it (including PTs ).

The first relates to overuse of diagnosis in practice and getting substantial illegal money for it. This again is also prevalent in PT and other pathies. I am not going into the issues highlighted in the program as we all know it is an open secret -that for every medical test the medical practioner gets at least 50 % as illegal black money (it should not be called commission- as it might be a legal tender for example what a real estate agent gets).
The first issue in requesting a diagnostic test is that it should increase your probability of the possible disease. Also we should have an assumption (a pre-test probability) that this person may be suffering from this particular disease and then do the test. You should not do it wily nily on all the patients. For example you do a test for malaria on patients with symptoms like paroxysmal symptoms of fever shivering body pain etc. You don’t do it on all the patients who come to the GP with fever. Or you don’t do preg-test for all the women who enter the OBG clinic.

However, this is what happens in case of LBP- either a MRI or a X-ray is ordered by –well any idiot with a pen and thinks he/ she is a doctor (which again includes PTs and other nonsensical profession like sidha etc). Why pray is a problem? - The biggest problem is we are going to have over diagnosis and lots of false positive. Second is the harm the patient is exposed to- the X-ray is not a torch light. Third is harm of teaching an anatomical or a pathological model of pain which is the biggest harm i presume, as it might impede the prognosis of the patient.
The second issue is a test (like an x-ray or MRI) should change your treatment after the patient undergoes it. For example, if you have a patient with LBP and you are thinking of exercise and some passive treatment like IFT or manual therapy after the patient has got an x-ray or MRI the treatment should change. I am pretty sure after X-ray none of PT management is going to change (if there is no red flag). A second example can be an x-ray for OA knee patient- will the treatment change because the patient has a joint space narrowing or osteophyte- the answer is no for any treatment. However, when a patient with OA is not getting better, his joint movements are very restrictive  and when you are contemplating surgery then you need a x-ray as it may influence your change in management- that is joint replacement.

Hence, most of the time if you are ordering for an x-ray – you should be thinking – does this patient has a red flag. That is we should be having a big concern or suspicion that the patient is having a systemic disease and that is causing the pain. Next if you are ordering for a MRI- probably the patient is being posted for surgery- as you can imagine surgery is different treatment than conservative management.

So cry babies in medicine should first learn medical theories and best practice methods and then cry wolf. The next post we will see why screening is good for only doctors and hospitals and not for patients.

So for medical professionals the lessons are if most of your patients with pain are getting an X-ray- you are over utilizing diagnostic tools. If you most of your patient are getting a MRI (for pain) the you are not only a moron you are also a cheat and a criminal (as you are also getting illegal money from the center)

For patients-  

1. Ask your doctor why and how will the “test” will help me in getting better

2. Even for a simple blood test ask the 101 question you ask you cable operator when he comes to collect the paltry sum of 100rs

3. Tell your doctor to f!@# off he tells you to get the test in his favorite lab-well go and complain in a consumer forum or just write nasty things about the system on the net- see what happened when a uneducated said nasty things about doctors

4.  Remember medicine is also a business not a noble profession (that was 30 years back) so shout at them when the service is poor or you are not satisfied- as in case of with your mobile phone operator

5. Read consumer summaries and guidelines issues to reputed sites like Cochrane (http://www.thecochranelibrary.com/view/0/index.html)

Reference:

1.       Appropriate use of diagnostic imaging in low back pain: a reminder that unnecessary imaging may do as much harm as good

Homer simpson: “What's the point of going out? We're just gonna wind up back here anyway.”