The need for lab tests in disease diagnosis

Recently, I saw an eight-month-old kid who had constipation since birth. On query, the patient had delayed stool passage after delivery, neonatal jaundice history, and intelligence seemed lower than other children of the same age. I advised a thyroid hormone tests to rule out hypothyroidism. The parents agreed to run the tests, which confirmed hypothyroidism, and I prescribed thyroxin.

Today, I want to talk about the investigations rather than the diseases. A thorough history taking, physical examination, and lab tests are required to validate the suspected diagnosis. Doctors are sometimes accused of ordering needless tests. Lab investigations often are necessary to confirm the provisional diagnosis before starting the treatment. But investigations must be logical and cost-effective.

We do investigations to confirm the diagnosis and to exclude the differential diagnosis. Before asking the parents/patients to do some investigations, especially while asking other than routine investigations, we should explain the rationality of investigations; otherwise, some communication gaps will be there and they may think something else. Because of this lack of explanation, doctors are being blamed unnecessarily. Our goal must be treating each patient with compassion, empathy, and transparency.

The author is a Professor of Paediatrics at Community Based Medical College, Mymensingh. E-mail: mmukkhan@gmail.com