Are they treating you or your test results?

As doctors, we often find ourselves in situations in which patients attend a consultation “because of the results of the tests.” Many times, patients end up consulting for merely incidental findings that have nothing to do with their health situation, but when presenting a highlight* between the list of blood tests fills them with anguish and fear.

A TSH result is not the same, for example, in a young, thin 23-year-old woman seeking pregnancy who has had fetal losses that exactly the same value of the same hormone in a 75-year-old man with obesity, even though the reference range is the same for both in the laboratory. One of these two cases will be prescribed targeted treatment and monitoring, the other will not.

A concentration of LDL cholesterol in an asymptomatic person with no history or risk factors is not the same as exactly the same measurement in a person with 2 heart attacks and diabetes mellitus, no matter how asymptomatic they are. One will not be allowed treatment, while the other will even be left with a complex combination of drugs to reach very strict goals.

It is not the same to measure a hormonal profile in a woman of reproductive age at a certain phase of her menstrual cycle than in another, nor is it the same to measure the same hormones in a postmenopausal woman; the same values ​​can mean very different things in each case. It is the art of the doctor not only to know how to interpret the result of the exam, but even the simple fact of requesting it from the beginning already deserves analysis and not automation.

Just because a lab result is outside the reference range doesn’t mean you need a drug, just as being within the reference range doesn’t mean you don’t.

Every laboratory test is insignificant if it is not accompanied by questions such as:who is it?, why was it measured?, do you already have treatment for this? Is this result reliable? How long ago was this measured, has anything changed in this time? what were they looking for when they asked for it?

When a doctor requests a laboratory test, he should first think about whether clinical decisions relevant to the patient will be made based on that result, whether drugs will be omitted, whether they will be added, or if, on the other hand, everything is going well and should continue the same with objective knowledge of the effectiveness of therapy.

Let us remember that laboratory data lack value to make decisions, that these need to be processed until they become applicable information for the benefit of the patient, a situation that deserves knowledge.

Dr. José Eleazar Girón Morales, Internal Medicine – Endocrinology

Reference ranges in laboratories sometimes harm the peace of mind of patients and sometimes generate prescriptions, or omissions, that are contrary to health.

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