Specifics vs general
New Delhi, April 16, 2019 :
Evidence-based medicine has become the norm today. Laboratory tests are now greatly relied upon in the diagnosis of a condition, its treatment and follow up.
Most often, we ask for liver function tests (LFTs), kidney function tests (KFTs) or a lipid profile as a whole, for instance, without mentioning the specific test/s in the panel. This is the general practice and it is done quite possibly to avoid legal consequences
In lipid profile, total cholesterol or high-density lipoprotein (HDL) cholesterol may be the only tests required. If HDL is low, then triglyceride (TG) level is high. High TGs indicate serum lipemia.
A good peripheral smear should be able to tell you about the white cell count (total and differential), platelets, types of anemia, parasites, sepsis, etc.
In non-alcoholic steatohepatitis (NASH), serum glutamic-pyruvic transaminase (SGPT), now called alanine aminotransferase (ALT), may be the screening LFT required.
In suspected hypothyroidism, thyroid-stimulating Hormone (TSH) is the only screening test required.
Urine routine and microscopic gives information about diabetes mellitus, renal disease or urinary tract infection (UTI).
Good clinical examination supported by peripheral smear, urine analysis should be able to give a diagnosis in most cases. A third test that can be done in chronic fever is ESR. All these 3 tests can be done in a clinical side lab. Further investigations can be done in a stepwise manner.
When a patient seeks health care, he/she looks for availability, affordability and quality. The issue of affordability is very significant in India as it has one of the highest out of expenditures on health in the world, which is over 60%. This contributes to poverty due to exorbitant health expenses resulting in further inequity in health services.
Universal health coverage is the answer to affordable healthcare of quality in the developing countries of the world including India.Universal healthcare provides Affordable, Adequate, Accessible, Available, Appropriate and Accountable quality and safe healthcare to the public.
As per the WHO, “universal health coverage implies that all people have access, without discrimination, to nationally determined sets of the needed promotive, preventive, curative and rehabilitative basic health services and essential, safe, affordable, effective and quality medicines, while ensuring that the use of these services does not expose the users to financial hardship, with a special emphasis on the poor, vulnerable and marginalized segments of the population.”
As part of the Choosing Wisely Campaign, clinical societies like the American Society of Anesthesiologists, the American Society for Clinical Pathology and the Canadian Association of Pathologists recommend that routine preoperative laboratory testing, including, CBC, coagulation studies, and metabolic panels for low risk surgeries without a clinical indication should be avoided.
By asking for specific test and not the entire panel of tests, it is possible to reduce treatment costs for a patient.
The Author of this article is Dr KK Aggarwal, Padma Shri Awardee