Wednesday, August 26, 2009

No indication, No test

Yesterday, one gentleman came to our A&E during my duty time and requested from my nurse to do a test for H1N1. The nurse asked him, did he has fever, cough or flu (the common symptoms of H1N1 illness). He replied, "No". So my nurse told him that there is no need to do the test because there is no indication. He insisted to have a test and said he is willing to pay. At last, the nurse asked him to see me.
I explained to him that : 1. He has no indication for the test 2. The test which is available at our hospital is a rapid test, it takes about 30 minutes to get the result but its specificity and sensitivity is only around 80%. Meaning that it only can say you have infection caused by Influenza A or B or both BUT cannot confirm it is H1N1. If the test is positive for Influenza A, the chances to have H1N1 infections is high. BUT due to reason no 1, I turned down his request although he is willing to pay. The issue is not that he can afford to pay BUT there is no clinical indication. This is not a good clinical practice. During my medical student time, my Professor of Medicine always told us the purpose of doing investigations in clinical practice. The professor named it as 3C - To Confirm the diagnosis, To find the Cause and To monitor the Complications. So doing the test for this gentleman is not fulfilling the purpose of 3Cs as he has no symptom. And it is not cost effective also.

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