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ADVANCE Perspective: Physical Therapy & Rehab Medicine

Testing, Testing

Published November 29, 2010 5:42 PM by Jon Bassett
It was just supposed to be a long lunch -- step out of the office, make the 10-minute drive to the hospital's ob/gyn department, sit through the ultrasound of our 20-week-old baby, and bring back a black-and-white photostrip to pin to the wall.

Maybe grab lunch somewhere on the way back.

The appointment, as they do, began innocently enough. Heartbeat? Check. Kidneys? Strong and healthy. "And see that? The baby's waving to you!" With that, the pleasant ultrasound tech explained that the radiologist would be in shortly, and have a nice day.

"When we perform an ultrasound scan, we're looking at the development of the fetus and for anything that may or may not be associated with a health issue," the radiologist explained, moving the wand over my wife's midsection. Understood. This was our third child. We knew the drill by now.

"I'm noticing something."

What was that you said?

"See this? The baby's intestine looks abnormally bright." As he squinted at the monitor, the physician went on to explain that this finding -- medical term, echogenic bowel -- is a "soft marker" for certain health conditions. While not diagnostic in itself, it's been correlated with conditions such as cystic fibrosis and Down Syndrome. Given our advanced ages (40 and 41), the anomaly placed us squarely in the high-risk group.

As he continued his monotone delivery of statistics and tests and probabilities, I felt my blood turn to ice. It seemed as if someone had placed the room on a spindle and spun it like a top. I felt my mouth asking questions that I didn't even care about the answers to. More than anything, I wanted to get out of that cramped room. I was suffocating. I needed air.

The debate over medical overtesting is nothing revolutionary -- it's been part of the national conversation surrounding cancer and heart disease for decades now. It seems to touch all the third rails -- Financial. Political. Religious.

Earlier this year the debate resurfaced when San Francisco cardiologist Dr. Rita Redberg argued in an opinion piece in the Archives of Internal Medicine that a slew of medical tests performed on President Obama were unnecessary, expensive, and perhaps dangerous. A summer of opinion-volleying followed, with media pundits on all sides chiming in.

Separate from the financial and health-risk controversies surrounding AFP, CVS, amniocentesis and other prenatal procedures is the ethical concern of what to do with all this information. In our case, if further testing had revealed that our child did in fact have a chromosomal abnormality or cystic fibrosis, there's nothing we could have done. Many parents forego testing altogether for this reason, of the mind that nothing the doctors tell them will make a difference.

Add to this the profound dilemma posed by false positives. Tests aren't perfect. A female colleague nearly terminated her pregnancy over prenatal testing that suggested a particularly dire health condition. She did not, and her baby daughter was born perfectly healthy.

As an opinion spectrum, of course, nobody is more "right" than anyone else -- it comes down to personal preference, comfort levels, and what you're emotionally prepared to accept.

Count me among the group who like to know as much as they can about what they're facing. Yes, it was a whirlwind summer of sleepless nights, Internet research and pointless speculation. Ultimately, our son was born with no issues. We have no clue what could have led to the finding on the scan. We're thankful.

But while it was a distressing journey, I'm still glad we took it.

posted by Jon Bassett

2 comments

Jon,

Touching post.  Difficult walk.  So glad to hear all turned out well.

Jason,

Good points, all.

A few more personal examples of medicine causing undo worry...

My second pregnancy I had to have emergency surgery during my seventh week.  As the anaesthesiologist put me under he was lamenting I wasn't further along.  He kept talking about how he would be so much more comfortable if I was just a couple of weeks further along as the risk of miscarriage from anaesthesia was so much less.  Everything was perfectly fine.  No complications.  

My third pregnancy had complications that took me to an emergency OB visit in my eighth week.  After an ultrasound, the doctor sent me home to let nature take its course.  Seven months later we had a healthy baby girl.

Another aspect of prenatal/perinatal testing is that there can be a misunderstanding about what some of the tests actually reveal.  Even as a medical professional, and a mom who had already been through the whole pregnancy drill, I had a misunderstanding of an OB test.  During one of my pregnancies (not the first), because of my "advanced age", I was being counseled to take a test.  I had always understood it to be predictive of birth defects.  The nurse explained it was not.  It only indicated whether or not you were in a high risk group.  If the test was positive, it merely meant further testing was indicated.  A positive doesn't even mean something IS wrong...just that you are in a group that has a greater risk of something being wrong.  My age already put me squarely into that group!  I decided to forego the unnecessary worrying that test was sure to bring!

One more example.  Two years ago I had a test that was indicative of cancer.  A more invasive test confirmed the initial findings and I was sent to an oncologist.  He was optomistic that surgery would both confirm diagnosis and be all the treatment I'd need.  We asked for a second opinion.  Because of the unusual circumstances surrounding the case, the initial diagnosis had actually come from the most reknowned GYN pathologist in the US, perhaps the world.  So, we were told a second opinion would be a waste of our money and everyone's time.  When your case has been attended to by the best, to whom do you go for a second opinion?  Seemed a logical argument.  A surgery, a complication, an ambulance ride, a hospitalization, an unforeseen six week recovery period, and hundreds/thousands of dollars later...they found absolutely no trace of any cancer.  I wasn't angry.  I didn't think there had been any malpractice or negligence.  I was simply grateful for the best outcome of all.

Tests are fallible and so are humans.  The most well trained medical professionals do not have a crystal ball.  There is no sure thing.  We "practice" medicine.  Medicine is a science, which means it is constantly evolving.  We can use the information to make informed decisions.  But when it is a matter of life and death, it is wise to always err on the side of life.  Just in case that situation is one of the instances where tests failed - or humans failed in their practice of medical science.

Janey Goude December 6, 2010 11:03 PM

Glad everything turned out okay.  Speculation is a difficult thing to avoid when tests show a "positive".  I agree more testing for those in a higher risk group can be helpful but the arguement is whether they are needed.  Still up for debate.  And if insurance pays for the test the likelihood of it being done is greater than if insurance doesn't pay.  As for the leader of our country- if the tests were not performed people would wonder why and whether he was hiding some health problem.  

Jason Marketti November 30, 2010 1:50 AM

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