Tests for everything

It's always on either a Monday or Tuesday, more often after a long weekend. A new patient comes in and wants to "check for everything".

"OK, Doc. I know I've been bad. But now I am ready to turn the new leaf. I need to know how much damage I've done to my body. Can you check for everything, cancer, AIDS, arthritis, ... EVRYTHING you can think of ... but make sure I don't have cancer".

This sort of requests put us doctors in a rather troubled spot.

The obvious problem is cost. We cannot order "everything". Mainly because we don't really know that many... . The menu is huge! Medicare will knock on our doors even before the delivery truck arrived. Do you know how much it costs to have your liver function checked?

But then, we are always intrigued by the repentant patients. It is an opportunity to scare the living day light out of the hung over and sorry being bfore us. If we refuse to order some of the tests, he or she may disappear from our "preventive medicine radar".

Another issue is that a normal test result does not mean you are well. Our body is a constantly changing organism. I guess inside my body right now there are a few thousand cells wanting to go cancerous. Some may aleady have become cancerous. They may not show up in the test result pages.

[By the way, don't worry. If you keep your general health in good shape, your immune system and its allied armies will track down these insurgent cancer cells and knock them off.]

Also, does a normal result some how reinforce the patient's delusion that his or her recent self-destructive behaviour is OK? "Great mate. All that drinking and smoking and eating did not affect my PSA level! What's on this weekend?".

The "Whole body scan to exclude all cancers" is ridiculously misleading and is a total waste of time and money! I can tell you that you have less cancer cells in you before you inflict upon yourself with this crazy gimmick! What if it finds a cancer in a peculiar spot that we cannot get to to know what it is? What if this cancer turns out to be a very slow one and can only kill you in 200 years time?

What we should test for are the proven worthy tests: fats, sugar, blood in poo. The PSA (prostate specific antigen) is a rather hairy issue - which I will not discuss here.

Tests are not your warranty. Let your doctor monitor your weight, girth, blood pressure, and every now and then stick a few small instruments into your body. Then we will order some tests.