Tag Archives: Lab tests

Unnecessary Tests

So something a lot of patients ask me is “Is this test really necessary?” The majority of the times a test is ordered it is necessary, but there are times when they are not. Let me define what I mean by necessary and unnecessary. Necessary, to me, is any test that will rule in, rule out, or confirm a diagnosis. Necessary tests guide treatment, letting the doctor know the next step in treatment, how to alter treatment, or when to stop.

Unecessary tests are tests that don’t really give me any new information that would help determine a diagnosis or change my treatment plan. Here are some of the reasons these tests are ordered.

1) Patient demands it. There are times when I know the XRay isn’t going to show anything because what they have is not something that can be visualized on XRay, but despite my best efforts to explain reasoning and the risk of radiation, they still demand it. It’s horribly uncomfortable to argue with a patient, and when they don’t get what they want, they just go down the block to the next doc. The practice loses business, and the doctor gets in trouble with the administration or suffers low survey scores which can lower reimbursements.

2) To cover our butts. Sometimes we simply have to do it to ” just make sure” and protect ourselves. And we also want to make sure we are doing everything we can for our patients. Better to be safe than sorry.

3) For documentation purposes. Sometimes insurance companies need proof in the form of lab/ imaging results that the patient indeed needs this treatment. Also, sometimes insurance companies won’t cover a certain test or referral that I deem necessary until another test is done beforehand.

4) And, I’m embarrassed to say it, but  some doctors do it for money. Not all doctors do this or want to do this but sometimes we are forced to do so. The last company I worked for wanted me to order sleep studies and ultrasounds on every patient as they were procedures that were done in house and could be billed. My constant refusal caused me a lot of humiliation and reprimanding. Other doctors do them to make up the difference in what they are being reimbursed by insurance. I am not justifying this behavior in any way and I believe that it is a very small percentage of doctors that do this.

Hope  this sheds a little light into the issue of unnecessary testing.

Ask the Doc- How often should bloodwork be done in a patient with lupus?

Bloodwork for patients with lupus is very important and usually is done regularly. How often it is done is based on the patient and the severity and activity/stability of their disease. Usually I get my bloodwork done every 4 weeks, but there were times when I was doing so great that I only needed to get my labs checked every 6-8 weeks. There were also times after a flare or hospitalization, or after my medications were changed/being adjusted where I had labs drawn every 2 weeks, and even once every week.

Lab tests are very important because  they provide you and the doctor with very important  information. Labs help us determine how active the disease is and how well the medications are working. It also can tell us if the medications are causing any unwanted side affects. It can also let us know if something new is brewing.

Some of the routine labs I get done are as follows;

Complete blood count (CBC)- This tells me if I am anemic ( low hemoglobin and hematocrit), or if I have low platelets or low white blood cell count.

Complete metabolic panel (CMP)- This checks kidney function, electrolytes , sugar levels, and liver enzymes.

Anti- dsDNA – These are antibodies to double stranded DNA which is a lupus marker and can help tell how active the lupus is.

Complement levels (C3 and C4)- Low levels of these can indicate inflammation due to lupus.

CRP: High levels of C-reactive protein can be indicative of inflammation and lupus activity.

Urinalysis: Abnormalities in the urine such as blood or protein can mean there are issues with the kidney.

And every once in awhile my doctor will order a vitamin D test and thyroid test.

Getting your blood checked regularly is an important part of lupus management, which reminds me it, it’s time to go get mine done!