You walk into my clinic, clutching a thick sheaf of papers. Twenty pages of test results when I only asked for two. Sound familiar?
Welcome to the new normal in Indian healthcare – where more isn’t just more, it’s potentially problematic.
The Allure of the Package Deal
It starts innocently enough. A “Master Health Check” here, a “Diabetes Package” there. Who doesn’t want to be proactive about their health? But when patients show up every three months with a novel’s worth of lab reports, we’ve crossed a line from vigilance to overkill.
The Bargain That Isn’t
“But Doctor,” they say, “it only costs 800 rupees for all these tests!” That’s the same price as the two I prescribed. It seems like a steal. A treasure trove of health data for the cost of a couple of multiplex tickets.
When it comes to medical tests, you often get what you pay for. And sometimes, you get a whole lot more than you bargained for.
The Pandora’s Box of False Positives
Let’s talk about the elephant in the room – false positives. When you test for 20 things instead of two, you dramatically increase the chances of an abnormal result. And once that genie is out of the bottle, it’s hard to put it back in.
Case in point
Mr Kumar came in for a routine check-up. His package deal included a test I still needed to write. It came back slightly abnormal. Cue the anxiety, the follow-up tests, the specialist referral – all for what turned out to be a lab error.
The Hidden Costs
Time. Money. Peace of mind. These are the actual costs of unnecessary testing. And they add up faster than you might think.
A study in the Journal of the American Medical Association found that false-positive results from cancer screening alone cost the US healthcare system $1.82 billion annually. Imagine the impact on India’s already strained medical infrastructure.
The Quality Issues
How can these labs offer so many tests for so little? It’s a question worth asking. While many labs maintain high standards, the race to the bottom in pricing can lead to cut corners.
A pathologist in Mumbai notes: “Quality control in medical testing is crucial. When prices are pushed too low, something has to give – and it’s often the reliability of the results.”
The Doctor’s Dilemma
Here’s where it gets tricky for us doctors. I’m ethically bound to act on an abnormal result after seeing it, even if I didn’t order it. This often means repeating the test at a more reputable lab—more time, money, and worry for the patient.
Sometimes, in the scramble to address these unexpected findings, we must forget the original reason for the visit. It’s like going to the mechanic for an oil change and rebuilding the engine.
Personal Experience
Last year, a 45-year-old software engineer, Mr. Reddy, came to my clinic for a routine check-up. He brought a thick file of test results from an online lab that offered a comprehensive health package at a discounted rate. Among the 30+ tests, most of which I hadn’t ordered, was an elevated PSA (Prostate-Specific Antigen) level.
PSA testing is controversial even when used as a targeted screening tool. For asymptomatic men under 50, it’s generally not recommended. But there it was – a result I hadn’t asked for yet couldn’t ignore.
What followed was a cascade of events.
1. I explained the implications of elevated PSA to an understandably anxious Mr. Reddy.
2. We repeated the test at a reputable lab, which returned normal.
3. To be thorough, I referred him to a urologist, who performed a digital rectal exam and suggested watchful waiting.
4. Mr Reddy underwent two more PSA tests, both normal over the next six months.
In the end, we concluded it was likely a false positive. But the process had cost Mr Reddy time, money, and significant anxiety. Moreover, his original concern – some mild gastric issues and migraine – had been overshadowed and delayed in treatment.
Research Perspective
A 2018 study published in JAMA Internal Medicine found that cascade events following low-value testing are common and costly. The study examined three low-value services: PSA testing in men 75+, head imaging for syncope use, and preoperative chest x-rays. They found that 12.3% of these tests led to cascade events, with an average cost of $1,228 per cascade.
Another study in the Annals of Internal Medicine (2020) examined the psychological impact of false-positive test results. It found that patients who received false-positive results experienced significantly higher levels of anxiety, even months after being cleared. This anxiety often leads to healthcare avoidance behaviours, potentially impacting future necessary care.
In the Indian context, a paper published in the Indian Journal of Medical Ethics (2019) highlighted the ethical challenges posed by the proliferation of health check-up packages. The authors argued that these packages often include unnecessary tests, leading to overdiagnosis and overtreatment, particularly in a healthcare system where many pay out-of-pocket.
The Broader Implications
This dilemma extends beyond individual patient care. It raises questions about resource allocation in our healthcare system. Every unnecessary test or follow-up takes time and resources that could be used for patients with precise medical needs.
Moreover, it challenges our understanding of the doctor-patient relationship. When patients come with reams of unsolicited test results, the dynamic can shift from a collaborative, symptom-based approach to a defensive, data-driven one.
Strategies to address this issue
1. Patient Education
I now explain to patients why more tests are only sometimes better and the potential downsides of unnecessary testing.
2. Selective Repetition
Instead of reflexively repeating all borderline results, I assess each based on the patient’s overall clinical picture.
3. Clear Communication
I’m transparent about the limitations of specific tests and the possibility of false positives.
While the abundance of health data can be a valuable tool, it’s crucial to remember that our primary role as doctors is to treat patients, not numbers. Going through this flood of information while focusing on the patient’s primary concerns is one of the most significant challenges of modern medical practice.
The Radiation Reality Check
Let’s not forget the X-ray factor. Many of these packages include imaging studies that expose patients to radiation. While the doses are low, they’re not zero. The International Commission on Radiological Protection warns against unnecessary medical radiation exposure.
A radiologist in Bengaluru advises: “Chest X-rays in asymptomatic individuals rarely provide meaningful information and should be discouraged as a routine screening tool.”
What’s the solution?
It’s not about avoiding tests altogether – it’s about smart testing.
1. Trust Your Doctor
We order tests based on your symptoms, our examination, and sometimes our gut feeling. There’s a method to our practice.
2. Question the Package
If a deal seems too good to be true, it probably is. Ask why you need each test.
3. Seek Quality
Cheaper is sometimes better. Invest in reliable testing from reputable labs.
4. Annual, Not Quarterly
Unless advised otherwise, stick to annual check-ups. Your body doesn’t change that fast.
5. Understand the Limits
No test is perfect. False positives (and negatives) happen. Don’t panic at every abnormal result.
The Research Perspective
Recent studies highlight the global concern over excessive testing.
A 2023 meta-analysis in the Lancet found that up to 30% of medical tests in high-income countries may be unnecessary.
The Indian Journal of Medical Ethics published a paper in 2022 calling for guidelines to curb excessive testing in India’s private healthcare sector.
A BMJ Quality & Safety Journal study revealed that doctors who order fewer tests often have better patient outcomes.
The Human Touch
Numerous cases have highlighted the importance of the human touch in medicine. Let me share three experiences that have profoundly impacted my approach to patient care.
1. The Power of Listening
I remember Mrs. Nagashree, a 68-year-old who came to my clinic with a thick file of test results. Her chief complaint was persistent fatigue, which had stumped several of my colleagues. They had prescribed various supplements and lifestyle changes, but nothing seemed to help.
Instead of immediately ordering more tests, I asked her, “Tell me about your day, Mrs. Nagashree.”
For the next 20 minutes, she opened up about her life. Her only son had recently moved to Australia for work. She spoke of the empty house, the quiet meals, the long, lonely evenings.
Recognizing the emotional root of her fatigue, I gently suggested, “Have you considered adopting a pet?”
Three months later, Mrs. Nagashree returned to my clinic. Her eyes were bright this time as she showed me pictures of her new companion, a playful Labrador puppy. She excitedly described their daily walks in Cubbon Park and how she’d joined a local pet owners’ group.
No new tests or medications were needed. The fatigue had disappeared along with her loneliness.
2. The Intuition of Experience
In my early internship days, when 9-year-old Rahul came in complaining of stomach aches, my first instinct was to order a comprehensive set of tests.
As we waited for the results, my mentor, Dr. Desai, happened to stop by. He started chatting with Rahul about school, friends, and his favourite cricket team. Then, almost casually, he asked, “Rahul, does your tummy hurt more when you’re at school?”
Rahul nodded hesitantly.
A few more carefully posed questions revealed that Rahul was bullied at school. His stomach pain was real, but its origins weren’t physical.
That day taught me an invaluable lesson. Sometimes, the most sophisticated diagnostic tool is simply a well-framed question with genuine interest.
3. The Healing Power of Touch
I recall a young IT professional, Priyalatha, who came to see me. Her file was bulging with inconclusive test results from various hospitals. She complained of recurring dizziness and weakness, which had led to a merry-go-round of increasingly complex examinations.
As I took Priyalatha’s hand, I noticed it was cold and slightly trembling. While we talked, I observed her rapid pulse and the nervous darting of her eyes.
Gently, I asked, “Priyalatha, when was the last time you felt truly at peace?”
This question opened the floodgates. Priyalatha began to speak about panic attacks, about fears she’d never voiced to anyone. No blood test or MRI could have revealed the anxiety disorder that had been masquerading as physical symptoms.
That day, Priyalatha’s healing began not with a prescription but a compassionate touch and a willingness to look beyond the numbers on her reports.
These experiences have reinforced my belief that while data and technology are invaluable tools in modern medicine, they can never replace the healing power of human connection.
In our data-driven world, it’s easy to forget that medicine is as much an art as a science. Numbers are significant, but they’re not everything.
My professor, Dr. T.D.Kshirasagar puts it beautifully: “The best diagnostic tool is still the doctor’s ears – listening to the patient’s story. No blood test can replace that.”
The Truth About Tests
Tests don’t heal. Doctors do. A good doctor listens first, then decides. Trust that process.
Next time you’re offered a buffet of tests, pause. Ask why. Consider the cost – not just in rupees, but in peace of mind.
Your body isn’t a mystery to be solved by a lab. It’s a story only you can tell. Find a doctor who listens to that story. Who understands that health isn’t found in a pile of papers but in the quiet space between patient and healer.
Choose wisely. Test sparingly. Live fully. That’s the prescription for true health.
In the end, the best test is the one you don’t need. And the best doctor is the one who knows that.
