Tag Archives: sick role

“Testing ad infinitum”

Take for example the patient who presents with “recent weight loss”, even though their recorded weight is exactly the same as it was 6 months ago.

…or the patient who “bounds” into the surgery, looking far healthier than the doctor will ever be, and then complains of “tiredness”.

…or the patient who has diagnosed themselves with “Chronic Lyme Disease” on the internet, even though they have never travelled to an area endemic for Lyme disease.

The temptation for the clinician in such cases above is to order a whole battery of tests in order to prove to, or reassure the patient that they have no organic pathology.

The patient then leaves the clinic with a whole list of (often expensive) laboratory investigations, and thinks to themselves;

“Wow, look at how many tests I am getting. The doctor must be worried for me. I really must be sick!”

And thus the cycle goes on. The tests come back negative, but the sick role is now reinforced. The patient then often comes back for more, or goes off elsewhere to seek a second opinion…

Worse still, if enough tests are performed, then one will eventually come back falsely equivocal or positive, confusing the issue even further for the clinician. And the positive reinforcement of the sick role in the patient has just gone through the roof!

Everyone is scared of missing something, of not diagnosing that long shot… But sometimes it is best just to trust good clinical acumen, and appreciate that laboratory testing can occasionally cause more harm than good…