Columnist Dr Copperfield considers why GPs spend more time scrolling through pathology results than they do in consultations
Put that needle and syringe down for a minute, will you, and listen. Where has our current bloodlust for lab tests come from? It’s insane. We have a Pavlovian reflex to print out a fully ticked pathology form before the patient’s got the seat warm.
I say we, and I do mean us GPs, but I mean noctors also, or perhaps especially. Which is why I have slightly strange consultations where I hear myself saying, ‘No, I don’t really know why the ANP checked your CA-125, coeliac screen, B12, vitamin D and caeruloplasmin either. But what I want to know is, is your sore throat any better?’
Well, at last, someone has noticed this, with researchers finding that one in four blood tests done in general practice may be unnecessary. And the rest. Bleeding patients is no longer a phrase of exasperation, it’s what our job has become. True, external forces are at play here. NICE guidance, QOF targets, defensive medicine, the use of a blood form as a get-out-of-consultation-free card now that prescribing an unnecessary antibiotic is bad and so on.
But really: it feels like clicking all the boxes on a path form has completely taken over the diagnostic process. And again, I’m pointing the finger at us all, not just noctors. But mainly noctors.
It’s compounded by the fact that a blood test feeds on itself like a self-harming vampire. A borderline result (and there’s always one) can lead to an indefinite agenda of repeat tests (think: TSH, pre-diabetes, borderline eGFR etc). And one abnormality can trigger an Oppenheimer test-bomb – an elevated ALT locally requires the testing of at least 18 further parameters, with the inevitable fallout meaning the patient feels ill even if they aren’t.
And if you’re not convinced, consider this. We see a lot of iron deficiency anaemia these days, right? Well, what do you expect when you’re bleeding the patient every five minutes? Though their suffering is nothing compared with ours, as we spend more frustrating hours scrolling through pathology results, taken by God knows who for God knows what reason, than we do in consultations.
We should remember the old adage, ‘Treat the patient, not the blood test’. The trouble is, these days, the blood test is the patient. We’re all at fault here. But mostly noctors. Have I mentioned them? I wish they’d bloody stop it.
Dr Copperfield is a GP in Essex. Read more of his blogs here