Investigation

Abstract

If there were no risks or disadvantages, all relevant tests would be done on all patients, and for a ‘complete check up’ many irrelevant tests would be done too. Tests are time-consuming and expensive, and if they are clearly unnecessary, doing them increases the waiting time for patients who really need the test, besides wasting scarce resources. Even the simplest test can be dangerous; there have been exceptional reports of gangrene following venepuncture. The amount of discomfort and danger varies from test to test; some carry a morbidity even in the best hands, which makes the ‘price’ that the patient has to pay for information quite substantial. What is less commonly acknowledged is that in the worst hands—and it is a statistical inevitability that some of us must have them—the morbidity is considerably higher, and the quality of the information which is obtained may be low. This alters the ‘price’.