“The doctor tested for everything” is a common refrain heard in many realms within medicine. As are its permutations. Heck, it is how these direct-to-consumer genetic testing companies pitch themselves—and, so successfully, I might add. Despite the fact “everything” is not possible to test for, the science for many of them is not there and spontaneous and acquired mutations are reality, the truth of their limitations typically never hits center stage in their marketing plans. Chasing “what ifs” usually perpetuates fear, anxiety and misplaced concern or worry. It is a false perception that such tests control our futures. While we worry so about what may happen, we tend to lose our ability to cope with what actually does —especially if one of these gimmicks said it was unlikely. The false sense of security they can yield might exacerbate a delay of seeking appropriate medical care when warranted, for instance, causing a larger problem. Probabilities are funny things in healthcare. They are not resolute. They are not certainties. They shift with time, aging, medication use, co-morbidities and lifestyle changes to name a few. No one tends to care much about the 80% likelihood of no risk for disease when they wind up falling into the 20%. So, ruling out “everything” is a fallacy. Of course there is utility in actionable prevention when risk factors are known, but seeking the right testing is essential to promulgating useful data. Otherwise, the harm can do you a greater disservice. We are very fortunate to live in a time where modern medical advances can provide much helpful information. And reliable testing abounds in medicine. Crucial to the picture is the medical professional who can communicate what results of tests actually mean, give truly informed consent and an understanding as a patient that panaceas are the unicorns. This shared decision-making provides superior outcomes and ensures reasonable expectations. This is the best way they can be met. Allergy blood testing is a big culprit. Casting wide nets when there are no defined symptoms merely to satisfy intellectual curiosity can beget unnecessary actions, some that can do harm. How often do you hear someone say, “Oh, I got tested for everything and they found out I am allergic to trees, dew, dairy, legumes, cats…It’s funny because I never have a problem when I eat dairy and I have had cats all my life?” This is because this type of test rarely correlates clinically, especially with someone who is without symptoms. The avoidance of dairy for this person as a result of these findings might promote a lack of vital nutrients that creates a cascade of ill effects. A doctor can rule out a heart attack when the proper tests are performed and within the appropriate span of time. He can rule out thyroid disease too. And anemia. And so on. But, saying “I am healthy, he tested for everything” has very little meaning and makes erroneous assumptions. You may be healthy if that is what the doctor conveyed. But, you only were tested for a specific spectrum of things and they reflect that period of time. If a physical exam was performed and blood work was sent off for a complete blood count and cholesterol. Then, if normal, you were only cleared of anemia, high cholesterol and other issues of your platelets, white and red blood cells. This testing says nothing— good, bad or indifferent— about your liver or kidney function, diabetes status, or thyroid. If you are symptomatic with fatigue, night sweats and weight loss, and he tested for “everything and it was normal” knowing what was specifically tested for is in your best interest. If there is no improvement or relief of symptoms, then expanding the differential is key to solving the puzzle. Anemia might have been ruled out, but were you checked for tuberculosis? And so on. Just because we can test for things, doesn’t mean we should. Harm can be done by it. Some measures are more precise than others. Intellectual edification can lead to a whole trajectory of acts that can pose their own risks. Discerning what to pursue, act upon and why is the reason doctors train to become doctors. The process itself and knowledge attained is intended to prevent unnecessary harm and escalation of intervention. The objective is to minimize risks for patients which includes selecting tests that are outweighed by the benefits and employing a systematic approach. Without that undertaking, irreparable harm can be done. There are situations where more can be more and less can be more. The stakes can vary drastically between eliminating dairy to putting a healthy pregnancy at unnecessary risk with invasive procedures. That’s only the beginning of what bad data can do. Good data can elucidate the best path, reduce risk and save lives. Identifying and lowering risks when possible is a wonderful thing. Understanding prevention is the goal. Just make sure the means to get there is a fruitful, legitimate one. This notion or concept that “everything” if negative or less likely is a static determinant in health is deeply flawed and often gives a phony reassurance. This in turn makes shock a dominating emotion when a disease actually gets diagnosed. How often do you hear of the wealthy individual who goes to a concierge comprehensive center and gets full body scans each year for a so-called thorough evaluation to get “everything” checked out, gets a clean bill of health then months later has a heart attack? Those full body scans done repeatedly might deliver more radiation than be of benefit, in particular when there is no significant family history, personal history, are no symptoms or known risk factors. They can pick up incidental discoveries, which can be a good or bad thing depending on the nature of the finding. To a cancer patient, these scans are critical to surveillance. To a healthy person, the analysis shifts. It is quite possible in this scenario his cardiac status might not have been properly emphasized when he was “tested for everything.” Never assume. Unless you know what exactly was studied, then you do not know much. “Everything” is a non-answer. Many indicators can be assessed to give a good bill of health and this can bring meaningful comfort. It is worthwhile to do so. It can provide guidance for improvement. It can give peace with certain worries. It just cannot guarantee or absolutely predict the future. Unexpected things happen in the ambiguity of life. By no stretch does it mean taking some precautions and monitoring certain risk factors isn’t of vital import. It just means put into context the meaning. Appreciate a lot can be avoided which is extraordinary, but “everything” is a reach. In pediatrics, it is a routine occurrence for new parents to arrive with baby in one hand and a belief in the other that all the prenatal assessments and extra services they paid for out-of-pocket guaranteed their offspring perfect health. I wish life worked that way. That screening for a handful of genetic or metabolic disorders may reveal cystic fibrosis is of little concern, but it says nothing about developing hypertrophic cardiomyopathy or arrhythmias, for example. Fortunately, knowing more about a family history and monitoring for those can lead to early diagnosis and intervention which has significant value. What’s the bottom line? What was specifically tested for was ruled out, nothing more and nothing less. And, for that moment in time, not necessarily forever after. Discerning, judicious use of current reliable studies and tests is the optimal way to achieve the best health —mental and physical—and make the most informed decisions in your own care. Beware of the motivations of much of the direct-to-consumer testing sphere which are frequently at odds with sound science and applicability to your life at present (or even future). Talk with your physician who knows you, your entire history and has examined you to discuss your apprehensions. Only he can convey the genuine risks and benefits of such studies and place any testing into context for you. Understand why some things are being studied and not others. Being informed will help you take charge of your health and replace excess worry with peace and calm—a recipe for better health. It will also clarify what risks you are willing to take and not take. Possessing realistic expectations of tried and true, even new therapies and diagnostics will ideally serve you in the short- and long-term. Source
