The People's Book of Medical Tests by Dr. David S. Sobel and Dr. Thomas Ferguson (Summit: $22.95, hardcover; $12.95, paperback)
American medicine for the past 30 years has been characterized by its technological advances, which are nowhere more in evidence than in the clinical laboratories and diagnostic centers that abound in every community.
Sophisticated machines automatically screen blood and urine and spit out rows of numbers that tell whether you may be at risk of having anything from a heart attack to a child who will develop Tay-Sachs disease. And, using computer imaging, ultrasound, electronic monitoring, magnetic resonance and plain old X-rays, physicians can also peer inside of practically every organ for signs of trauma, malignancy or other abnormality.
Like other similar books for laymen, this one devotes most of its space to describing each of the several hundred procedures in use today, the reasons for performing them, how it feels to undergo the test, the risks, the cost and other information that is of value to helping patients understand what all that technical language in the test results has to do with what ails them.
Planting an Idea
Learning, for example, that amylase is a digestive enzyme that changes starches into sugars should help patients with certain abdominal complaints to understand why the doctor wants to check their amylase level. Amylase, incidentally, is produced in the pancreas, among other places. Normally, very little of the enzyme is present either in blood or urine. So, if the test detects some there, the doctor has a clue that might lead to a conclusion that something is amiss in the pancreas.
One of the things that distinguishes this book from others of its kind is that it offers more than a simple translation of technical language. It goes further by planting in the reader's mind an idea that some physicians will perceive as the seeds of rebellion.
According to some estimates, diagnostic tests and the fees to evaluate them, account for nearly half of the nation's total health-care bill. At a time when the cost of health care is a top national concern, one might ask whether the tests are being overutilized. The physician authors of this book ask that question and leave little doubt that they believe that more tests are being done than need be.
Sobel and Ferguson declare frankly that they wrote the book to make patients realize that the decision to have or not have any diagnostic test (except in emergency situations) is the patient's responsibility, not the physician's. Yet, they point out, most doctors order the tests without much explanation, and most patients never exercise their right to ask questions or make the final decision. The authors obviously believe that one way to improve the doctor-patient relationship is to create better informed patients who then exercise their knowledge.
Testing at Home
It's unlikely that by reading one book patients will become experts and be able to reduce the national health budget by much, but knowledge has a way of expanding if the learner is motivated.
The chapters on preventive self-examinations and diagnostic tests that the patient can do at home may be useful. Included are tests for vision, hearing, dental plaque and lung function. There are also descriptions of kits that can be purchased to measure things like pregnancy, blood sugar and bowel cancer.
Elsewhere, Ferguson has declared that society is becoming "painfully" aware of the limits of professional medicine. He predicts that the health-care system is rapidly acquiring an image designed by the preventive-minded, health-active layman, rather than by the technological, disease-oriented physician.
That sounds optimistic, but if he's correct, this book should help patients achieve the best of all possible worlds: a reliance on self to maintain good health and a familiarity with the technical when its need arises.