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Thursday, March 27, 2014

Disinformation in the Information Era: Interpreting Patient Results

Be careful when interpreting results of medical tests Too often as a medical professional we find ourselves confused by the information patients give us about their medical history. The reasons are many, but very often it is a case of incorrect information that has been taken from test results. Test results are first of all one piece of information in a woman's medical case. But the test has to be interpreted correctly. For starters we hear our patients reporting that a particular test they had was "normal" or "abnormal" rather than "97% chance of normal" or 95% chance that this means abnormal. There is no up front acknowledgement that the test has limitations, and it's the very savvy patient that inquires about those odds.  A test run in an "at risk" group may be very inaccurate when run in a low risk population. This is due to a complex set of reasons that are beyond the scope of this discussion, but it is true. The correct way to discuss this with your gyn would be: how should I interpret this data given my medical history and risks, not "doctor were my numbers 'normal'". One good example is how we test bone health: the DXA. The numbers are translated into a score. That score is reported as "T-scores" which are powered to give postmenopausal women their diagnosis of bone health or bone disease in the form of osteoporosis. The DXA x-ray will give a number, and that number, is then interpreted based on actual studies of risk. For premenopausal women their number should not be interpreted by the T score, but instead the Z score is what should be applied. Yet some reports leave off the Z score allowing patients and their gynos to look at the results incorrectly. Communication is critical in most areas of life, but especially when communicating results using terms like 'negative' which sounds bad, but is good in most cases! A patient was told her HPV tests were "negative for the high risk types 16 and 18" which led her to believe that she had only "low risk types." New mammograms seek to clarify test limits by describing the density of the breast tissue as well as the presence of suspicious areas. Yet I have had a patient describe her mammogram as "too dense" to be interpreted at all, so she stopped having mammograms. That was not the intention of the additional information which is to help the interpretation of the report. The information era needs to have a goal of helping to clarify results, so as to minimize disinformation in the information era.

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