Necessary Medical Tests

After Josh staggered across the finish line, he collapsed on the track. He was taken to the medical tent. He was pale, light headed, and very tired. He said he just wanted to sleep. The paramedics were called over to check him out and they recommended he go to the Emergency Room and get some fluids in him. There was no way he was going to make it to my car so he went in an ambulance and I drove to the hospital.

At the ER I found that the ambulance crew had started an IV and Josh was beginning to look and feel better. Blood was drawn for testing and they ran an electrocardiogram. Then the doc told me they'd also like to do a chest X-ray. Curious about that, I asked what he was looking for.

The doc asked if I had ever heard of athletes who suddenly drop dead. Yes, I had. He said there's a rare heart condition that affects about three or four athletes every year. I remarked that there are a lot of athletes to which he agreed. (Let me note that I was looking at the rationale and logic for ordering a test to rule out a very rare condition, but I apparently didn't come across that way. I need to work on explaining myself better.) Misinterpreting what I was getting at, he asked if this was going to be an extravagant personal expense. Not at all, my insurance was going to cover this ER visit and all tests the doctor felt were necessary.

"No," I said, "I wondering if this is a necessary test." Again, I'm not explaining myself well. The doc's demeanor iced over. He got defensive and said he was not trying to churn tests to generate revenue. I missed the clue to reassure the doctor that I did not think he was trying to rip me off.

Here's what I was thinking but not saying: If this is something that affects three or four out of millions of athletes, then we're talking about minuscule odds. Heck, even even if we're only talking about athletes in Eastern Washington, the odds are still extremely small.

I (poorly) explained again that I was questioning the need for the chest X-ray since the purpose of it was to rule out something that's extremely rare. To that he replied, "Well, maybe I overstated the rareness of it." And to that I left unsaid, "If you're not sure of what you're talking about, how can I be?" But I thought that.

The doc reassured me that if it was his child then he'd want the X-ray done. Dang! He nails me with the guilt trip. Because "What if..." and "just in case..." The scene of explaining to Kathy why Josh suddenly dropped dead when I could have had that X-ray done popped into my mind. Totally unfair. But the deal is, I wasn't stopping him from doing the X-ray. I was trying to get a clear and logical reason for doing it. After all, the evidence we had before us was that Josh was very dehydrated and had obviously overexerted himself. The fluids being pumped into him were obviously bringing him back to a normal state. His color returned and he was alert and pretty much back to his normal self.

But now the doctor had to have me say "uncle" by asking me to allow the X-ray. I did. After all, what if, right? Unsurprisingly, the X-ray showed nothing wrong.

Set aside reactions to my side of the story--I'm not looking for validation or anything--and ponder this instead. Do we evaluate and respond logically to the risk factors in our lives? With or without the X-ray and even with all the safety features built into vehicles today, Josh has a far greater chance of dying in a vehicle accident than of this rare heart condition. And yet I allow him to drive a vehicle as well as ride in other vehicles. Instead of three or four athletes, we're looking at over 40,000 people dying every year. Would it be just as prudent, if not more so, to keep Josh off the road as it is to have that X-ray done? Maybe, but hardly practical.

And there's the conundrum we're faced with. At the hospital we often want everything done regardless of the likelihood of success or failure. It's easy to see why when you consider the leading causes of death. All of them involve a disease or some type medical condition except for accidents. And when you think about it, that's normal.

But how do you know when you reach the point where you say stop? Whether it's a test or a procedure, regardless of the expense, do we look at the need or likely result and recognize the odds are so small that there's really no sense in having it done?