A patient just called up asking for an appointment . She had irregular cycles, and wanted to know if she should get blood tests done to check her hormonal profile for TSH,PRL, FSH,LH and AMH done before coming to see me.
I was very pleased she was well-informed – and it's true that a lot of diagnosis in modern medicine today is based on lab investigations. In fact , there are some neurologists who look primarily at the CT and MRI scan to make a diagnosis, rather than examine the patient
While it's true that tests have a useful role to play, it's equally true that they need to be done properly in order to provide value to the physician and the patient.
This is why I requested the patient to come and see me first , so that I could guide her as to what tests she needed to do; and when and where to do them.
There's very little point in doing tests from an unreliable lab ; or at the wrong time of the cycle. Not only do these waste the patient's money , we are forced to repeat these tests in order to come to the right diagnosis, which causes the patient even more angst.
So why do doctors sometimes ask patients to do tests before coming for the consultation ? One advantage is that it saves the patient time , and if the doctor can review the results at the time of the consultation itself, he can come to a diagnosis earlier , and does not need to call the patient back. However , I think this is putting the cart before the horse.
After the consultation , I will ask the patient to do the needed tests , but she does not need to come back to see me in order for me to interpret the results. It's possible for her to e-mail me the results so that I can tell her what needs to be done next. I find this much more efficient and effective !
Of course, the advise is different if patients need to come from out of town for treatment. For them, it makes sense to do their preliminary tests locally, because if there is a problem, we can correct it before they come here. Even for these patients, I prefer that they email me before doing the tests, so I can make sure these are done properly !