This is the 160th #WILTW

In medical school you are swept away by the prospect of doing good. While you appreciate you are naive you don’t realise there are many unknown unknowns. At the time, therefore, it seems illogical working out what is wrong with someone can cause more harm than benefit.

As you grow in experience, both good and bad, facilitated and self-learnt, it becomes clearer that the “Gregory House” school of investigative medicine really is a recipe for disaster. There are very few ‘tests (blood or otherwise) that make a diagnosis for you. From white cell counts to spot sepsis and x-rays to find pneumonias, these investigations  just alter the patients’ prior risk of illness. Positive or negative they don’t definitively tell you whether someone has a disease.

In paediatrics there is the additional challenge of the test itself doing harm. Blood tests are not an enjoyable exercise, for child or family, and the benefits must outweigh the risks. Even with the most effective distraction and analgesia if a child’s first memory of a hospital is an unpleasant one, subsequent visits become more challenging. And for the child who already has had multiple blood tests and cannulas, that solitary precious vein for use in an emergency does not need unnecessary damage.

And what happens if you are not successful? Even the most experienced practitioner has a bad day. Do you really need that test? Will you have 3-4 further attempts and then decide it is not required? What does that tell the parents, and what does it say about your decision making?

In an era of over-diagnosis we must consider the consequences of investigation as a similar challenge of our time.

What have you learnt this week? #WILTW

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