A doctor who requests additional tests can quickly cause concern in his patient, especially when the prescription mentions a blood test, a CT scan, an MRI or a biopsy. However, according to Dr. Gérald Kierzek, emergency physician and Medical Director of True Medical, this prescription firstly responds to precise medical logic.
Additional examinations, what this means in practice
For Dr. Gérald Kierzek, “carrying out additional examinations means that the doctor prescribes additional analyzes or examinations in relation to the basic consultation (questioning + clinical examination), in order to obtain information that he cannot obtain simply by speaking and examining.
For the patient, it starts with “receive a prescription with one or more prescriptions“. He may then have to “make an appointment in a laboratory, imaging center or hospital department“.
Then comes the moment of “carry out the examination (sometimes with preparation: fasting, stopping certain medications, etc.“. Once this is done, it is necessary “retrieve the results (often within a few days to a few weeks) and report them to the doctor.“
“Repeat a follow-up consultation to interpret the results, adjust the diagnosis and treatment.“
Why does the doctor order these tests?
Prescription is not done simply to multiply analyzes or examinations. Dr. Gérald Kierzek specifies: “the doctor only prescribes additional tests if they are useful to modify his care.“
The history and clinical examination may not be enough to be certain of the diagnosis or choose the appropriate treatment. Several hypotheses may also remain possible and require examinations to confirm or rule out certain avenues.
Confirm a suspicion or rule out an illness
The doctor can try to “confirm a suspicion“, for example in the event of infection, anemia, diabetes or heart problems.
In other situations he may want “eliminate a serious or urgent illness“, such as a heart attack, stroke, cancer or thrombosis.
Examinations can also allow “assess the severity of a known disease“, with for example an assessment of the extent of cancer or an assessment of kidney failure.
Monitor a treatment or an anomaly
Another reason is “monitor the effectiveness of a treatment or monitor side effects“. Dr Kierzek cites in particular the liver assessment under certain medications or the CBC under chemotherapy.
A health check may also have revealed an abnormality, such as high cholesterol or borderline blood sugar. The doctor can then seek to clarify the risk or identify a possible cause.
Prevention can also justify the prescription of tests.
In all cases, the principle remains the same: “Generally, unnecessary examinations are avoided: we only prescribe if the result is likely to change the therapeutic decision.“
The different types of additional examinations
The laboratory
Additional examinations can first go through the laboratory:
- CBC (blood count): red blood cells, white blood cells, platelets (anemia, infection, etc.);
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CRP, ESR: markers of inflammation;
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Blood sugar, HbA1c: screening and monitoring of diabetes;
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Lipid assessment: cholesterol, triglycerides;
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Hepatic (transaminases, bilirubin) and renal (creatinine, urea) assessment;
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TSH: thyroid function;
- ECBU: urine analysis for urinary infection;
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Serologies: (HIV, hepatitis, etc.) depending on the context.
The images
Imaging constitutes another large family of complementary examinations:
- X-rays: (lungs, bones, abdomen);
- Ultrasounds: (abdomen, thyroid, breasts, vessels, pregnancy);
- CT scan: brain, thorax, abdomen, bones;
- MRI: brain, spinal cord, joints, soft tissues;
- Mammography: screening and assessment for breast cancer.
Functional explorations
Additional examinations are not limited to analyzes and imaging:
- ECG: electrocardiogram for the heart;
- EFR: respiratory functional explorations (breath, asthma, COPD);
- EEG: electroencephalogram (epilepsy, neurological disorders);
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Endoscopies: gastroscopy, colonoscopy, fibroscopy;
- Biopsies: taking a tissue for analysis (often if cancer is suspected).
Additional examinations do not necessarily mean serious illness
This is often the point that worries patients the most when a doctor adds tests to the consultation. Dr. Kierzek’s response is direct: “No, absolutely not. Prescribing additional tests does not automatically mean ‘serious illness’.“
The prescription may simply be used to confirm a common problem. “The doctor wants to confirm a banal diagnosis“, such as angina, cystitis, iron deficiency anemia or hypothyroidism, in order to adapt the treatment.
A precaution, follow-up or symptoms that are difficult to interpret
The doctor may also want to rule out a serious cause as a precaution, while the probability remains low.
Another possibility: “He does a routine or follow-up check-up“. A lipid profile, blood sugar level or treatment monitoring can therefore lead to additional tests without a serious illness necessarily being suspected.
Finally, “symptoms are nonspecific“, such as fatigue, diffuse pain or headaches. The doctor can then seek to refine his understanding before making his diagnosis.
Dr. Gérald Kierzek recalls that “in many common cases (general medicine, pediatrics), the questioning and clinical examination are sufficient to make a reliable diagnosis, and additional examinations are only requested to clarify, confirm or monitor, not because we systematically fear the worst.“
Three questions to ask your doctor
When a prescription raises questions, the patient can ask the doctor what hypothesis he is trying to verify and what the results will change. Dr Kierzek suggests in particular asking:
- “What hypothesis are you seeking to confirm or rule out with this examination?” ;
- “How will the result change my care?” ;
- “Are there other options (watched waiting, trial treatment)?“
In any case, if you have a concern, you can contact your doctor to ease your anxiety and ask your questions.