August Focus

[摘要] ‘We'll just organise some tests’ must be one of the frequent clichés of modern medicine. Ordering tests is something we do all the time, one of the three major outputs of primary care that cost money, yet it's an aspect of work that we question little and understand less, and it's good to be able to shed a little light on the subject. Start with the clinical prediction rule on page 606, where the authors have quantified the effect of treating patients with urinary symptoms on the basis of dipstick results. The effect of following the rule could be to reduce some antibiotic use, but this will mean not treating some women with infections. As they say, the aim is not to target antibiotics perfectly, but to do so more appropriately. The paper on page 587 reminds us of another risk of doing tests; here some patients felt stigmatised by finding that they were positive for Chlamydia. Then there are X-rays. In the past GPs have often been criticised for the numbers of X-rays ordered that turned out to have negative results. The standard answer has always been that negative ones are often useful, and the study on page 574 has confirmed that this is so, with the authors concluding that some of the negative X-rays meant hospital admissions avoided. They also recorded the reassurance that negative X-rays could provide, but pointed out that the doctors were more likely to be reassured than the patients themselves. The study on page 570 found that 23% of patients diagnosed with lung cancer were found to have had negative chest X-rays in the preceding year. The leader on page 563 sums it all up with a warning that with improved access to a wider range of imaging techniques, we have to remember at all times that they are not infallible. We must take care not to be seduced by the technology into believing that it will always provide us with perfect answers.

[学科分类] 卫生学