Unneeded tests

I have recently been reading some reviews about veterinary hospitals and doctors. For one clinic, the majority of reviews were great - ones that I would love to have and, well, lucky for me I do have that type also. But there were a few, a small percentage, that complained. Some of them actually gave 4 of 5 stars, but their comments were not so flattering. 

In those cases nearly all of them mentioned money. A few mentioned that the doctor would not allow services to be paid for later. Unfortunately for way to many veterinarians we know later never comes. Many people that do not have their finances figured out today will not have them figured out tomorrow. That is my personal bias. I said many, not all. Believe me, all veterinarians wish their clients were financially sound. 

One thing that struck a chord for me was an unhappy reviewer noted that unneeded tests were done on her sick pet. So, I’m trying to figure out what IS an unneeded test. I have a whole book of tests that can be completed by the lab. I went to school to help determine which tests should be completed in a logical order. In particular my instructors made me describe why I wanted to complete a test before it could be authorized. Even in just casual discussion with my peers we regularly may ask each other about the logic for running any particular test. 

When the unhappy reviewer clearly stated they took their pet in because it was sick how did they know a test was unneeded? Why would they authorize a test they think is unneeded? I suspect in retrospect they really are suggesting that the test results turned out to be ‘within normal limits’ which is very different than ‘not needed’. 

When veterinarians are faced with a sick patient we need to figure out what is normal and what is abnormal. Knowing what is normal has as much value to medical professionals as what is abnormal. Some patients will have multiple systems affected by their condition. If we only tested until we got a single abnormal result we may miss the most important problem. We need to sort out a variety of problems so we can diagnose a condition and rule out other conditions. It helps us determine the need for treatment as well as the treatment choices indicated. We also need to know what is normal because some medications and fluids must be used with respect to certain organs functioning properly as those organs will metabolize the drugs.

One common diagnostic test is a ‘general’ panel. It is done on blood and gives us basic information about the kidneys, liver, gall bladder, blood proteins, electrolytes and pancreas. If my dog is sick and I run a panel on her I am THRILLED that her ‘general’ panel is normal. I then know that her kidneys, liver, gall bladder, blood proteins, electrolytes and pancreas are normal (or near normal). I would not be happier if the panel revealed renal failure, liver disease, pancreatitis, etc. 

I get clients that ask me at times if a test is needed. I tell them that I would not recommend a test if it was not indicated. Need is not really taken into account when a diagnostic plan is formed.