Julian
What hits me about this debate---what tests should be done if any---is
that we, while trying to be rigorous about it, are ending up confused as
to why we are testing.
Easier to give an example;
someone on statins and/or quite overweight and/or on a SSRI may have
abnormal LFTs, probably mildly, and for no other reason.
Should we do the LFT in the first place? Opinions differ on routine LFTs
while on statins.
Let's say pt not on meds but has BMI of 32.
Will the abnormal LFT be of value to management? Yes. Reasons omitted
for brevity.
But say thin person, taking only a SSRI. Should they have LFT done? I
would say not.
Take apparently normal person, BMI 22, swears they have one glass a wine
a day. Say 45 years old, would like lipids and BP done. On no meds.
Should this person have LFTs done?
Because that would be screening as opposed to case finding or checking
for side effects.
Would doing LFTs here fit the Wilson Junger criteria for a screening
test? Probably not since we would not be looking for one particular
ailment. We might wonder if he is telling the truth about his drinking,
we might wonder if he picked up Hep B somewhere or has he chronic
hepatitis of some other variety, we might think of haemochromatosis if
we had a few in the practice but my point is that in this case we would
not be screening for one specific illness.
And therefore we should not do the LFT.
Comments?
Declan
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