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I have unexplained symptoms. Why is my doctor refusing to do more tests?

The question: I have been investigated with many tests for symptoms that are to date unexplained. I have seen two different specialists and still no answer. I spoke to my doctor about doing more tests but he told me that it would likely not give us any new information and could potentially harm me. I trust my doctor, but I don't understand how these tests can be harmful. Isn't knowing more better for your health?

The answer: This is a challenging situation that many patients and doctors face when dealing with symptoms that remain unexplained. This uncertainty can leave patients feeling scared and frustrated, while doctors feel worried that they haven't provided a cure or relief.

Before stopping investigations, it is first important to review with your family doctor that all the necessary tests have actually been completed. It is understandable why you would want to continue looking for an answer, but the truth is, too much testing and treatment can actually be more harmful than helpful. More is not always better, as every test carries its own potential risk of causing complications, physical discomfort and emotional stress.

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The main guiding principle in medicine is: "First, do not harm." Possible risks include: radiation exposure of an X-ray or CT scan, bleeding or infection from a biopsy, or potential side effects of medications. It is also not uncommon that when we are looking for one thing, we find something else on a test that may be of little or no consequence to our patient's health. Yet when something is found, we then have to follow up with further testing that also carries risk. Finding something that is inconsequential can cause a great deal of stress and anxiety.

It is important to note that over-testing and treatment is often driven by doctors. In the world of medical uncertainty, when we do not have an answer to a concern, we will do our best to investigate and find a cause. While often done with the best of intentions, studies have found that doctors may over-test and prescribe too many treatments due to the fear of missing something, worry about being sued, or inexperience. Always ask your doctor why a particular test is recommended and if it will make a difference to your condition and to your overall health.

There is also a potential societal cost. In order to continue providing publicly funded medical care in Canada, appropriate judgment and decision-making must be applied by doctors. In response to this need, the Canadian Medical Association has begun addressing the issue of over-testing by reviewing the evidence behind common tests to give guidance on which ones are necessary and which ones may cause more harm than good.

Keeping these things in mind, try to work with your doctor to find a balanced approach to testing. Be sure that you have had all the appropriate tests but be cautious to not be over-tested. Every patient is unique, so having an open discussion of what is most appropriate and safest for you will help guide you and your doctor toward a suitable treatment plan.

Dr. Sheila Wijayasinghe is the medical director at the Immigrant Womens' Health Centre, works as a staff physician at St. Michael's Hospital in their Family Practice Unit and at Hassle Free Clinic, and established and runs an on-site clinic at Women's Habitat Shelter in Etobicoke.

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