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Diagnostic Tests to Reassure Patients

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 From time to time, I arrange diagnostic testing to ease patients’ minds. 

“Could you scope my esophagus?  My boss was just diagnosed with esophageal cancer.” 

“I know I’m not due for my colonoscopy for another 2 years.  But I’d like to do it now just to be on the safe side.  My wife is worried.”

“No, the abdominal pain hasn’t changed since I had a CAT scan for it months ago, but maybe I should have another scan now just in case something new developed?”

When these requests are offered, I do not automatically acquiesce.  I try to understand better the genesis of the anxiety.  Is it rational?  Is it emotional?  Is there a true medical indication to justify a diagnostic test?  I interpret requests for tests as invitations for dialogue.  Very often, the ensuing conversation can settle the issue entirely obviating the patient’s testing request.  These patients don’t really want a test; they want to be reassured.  Physicians use these skills every day.  I can’t count how many times I have been asked, “You don’t think this could be cancer, do you?”  While there are no guarantees in life, there are many circumstances when we can dispel the patient’s cancer fear in a conversation.  However, we physicians choose our words with care.  Which of the following two responses would you expect from a seasoned clinician?

I am certain that you don’t have cancer.

There is nothing in your history or exam that raises any suspicion that you have a serious condition, such as cancer. 


Might these anxious folks in Edvard Munch's painting, entitled Anxiety,
be worried that they have a serious medical condition?

But there are certainly instances when I, and every other clinician on the planet, have ordered a test just to reassure an anxious patient.  I maintain that this approach when used judiciously is justifiable an delivers tangible benefits to patients.  Critics may find this practice to be ethically problematic.  Is it fair to consume resources or to expose patients to risks of complications or to occupy an appointment slot for a test when there no actual medical indication to proceed?   Is it fair for an insurance company to cover these procedures?  Or, should we consider a need to be reassured as an actual medical indication?

If a patient is anxious, there is no guarantee that a negative test result will end the process.  The patient may then propose additional testing 

There may also be times that we physicians are the driving force here.  A doctor may need to be reassured that nothing has been missed and this may lead to more testing. 

I wish we could reassure everyone that they are and will remain well.  I wish the same for me and my loved ones.  But, as we all know, cold reality can collide against us without warning or invitation.  Nevertheless, we should do all that we can within reason to feel reassured

 

 

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