Can I have blood tests to check everything is alright?

• Published in: BMJ (Online) Vol. 382; p. e075728
• Main Authors: Buss, Lewis F, Spitzer, David, Watson, Jessica C
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 05.07.2023
• Subjects: Asymptomatic; Biopsy; Blood tests; Family medical history; Heart diseases; Hematologic Tests; HIV; Human immunodeficiency virus; Humans; Laboratories; Patients; Primary care; Workloads; United Kingdom > UK
• ISSN: 1756-1833; 1756-1833
• DOI: 10.1136/bmj-2023-075728

Explore his ideas, concerns, and expectations by asking, for example, “What do you think a blood test will tell you?” or “What made you come for a check-up now?” Individuals requesting routine health checks often have specific health concerns (such as cancer, HIV infection, heart disease, family history), psychosocial issues,2 or undisclosed symptoms3 that are the true reason for seeking care. Patients who want blood tests in primary care often expect them to yield a large amount of information about their health, provide a clean bill of health, or diagnose serious conditions at an early stage without error.4 This misconception may be difficult to challenge, especially when it has been reinforced by previous healthcare interactions. [...]when a full blood count is done as an “MOT,” 1 in 10 will be abnormal, but less than 1 in 100 will lead to any treatment change for the patient.7 Blood tests and check-ups are better targeted for specific situations and life stages where evidence of their benefit is more clear.8 Discuss the harms of overdiagnosis and testing There are several harms that you could discuss with the patient depending on their priorities and values: False positive results and blood “incidentalomas” may lead to unnecessary anxiety, treatments, and cascade testing9 with potentially harmful invasive procedures (such as biopsies) or irradiating scans (such as x rays and CTs): “Starting doing tests can be like lifting the lid on Pandora’s box,” “If we find an abnormality, these are some of the next steps we may need to take” Diagnosing subclinical conditions may increase the cost of health insurance in some countries and result in poorer self perceived health and wellness10 False reassurance which may delay diagnosis or mean we don’t focus on lifestyle changes2 that could be most beneficial Many patients do not feel reassured by normal tests or are only briefly reassured.11 A “more is better” mindset is pervasive within medicine.