"Just one more." You never know what a test could lead to if you don't discuss it with whomever is ordering it. Why is it being ordered? What are the risks? Are there any alternatives?
Marilyn Bauriede, a retired attorney in California wrote about her personal experience with this phenomenon. Making decisions as to 'what to do' when offered options is hard. It's harder still when both the disease being tested for and the test itself can be harmful. In this case, there was a question of heart disease, but it would have to be justified in view of the radiation of the test (cardiac perfusion, AKA MUGA) and contribution that might have to an increased risk of cancer.
Hmmmm... what to do? Lately we've been learning that cardiac catheterization is performed on a lot of people who don't need it, and stress tests might not be as accurate or important as once thought. Heart disease is scary, but some of the tests are invasive, risky, and (for US patients or for Canadian Tax Payers) expensive. Plus, they might lead to MORE tests!
. . . That’s when a light bulb turned on in my brain, as I recalled the cardiologist telling me there was a 70% chance the perfusion test would reveal nothing at all wrong, or at least would not show artery blockage. I thought, “There’s way better than a 50% chance the test will find me heart healthy.” Even my PCP had said the ECG and stress test were not very accurate. That would mean they might have been wrong. And if that were the case, then having the perfusion test would needlessly subject me to health risks and no clear benefits. I needed to put the brakes on to more testing and seek a second opinion.
It's interesting to see from the patient perspective how the facts and uncertainties are explored. Ultimately, the situation was resolved because of a good connection with a physician, a thorough review of history and past tests, and probably a bit of wisdom from patient and doctor alike.
Read more in JAMA.