Episode Transcript
Dr. Miller: Do you need standard laboratory screening studies during your examination? We're going to talk about that next on Scope Radio.
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Dr. Miller: Hi. I'm here with Dr. Jerry Hussong. He is a clinical pathologist and the Chief Value Officer for ARUP Laboratories here at the University of Utah. Jerry, it's pretty typical for most physicians in primary care to order a set of laboratory studies, a full blood panel, a complete metabolic panel and sometimes a lipid panel and we do this almost routinely, reflexively. And I guess for the patients out there, maybe you could tell us what's the value of getting these tests if you are totally healthy? Do you think they're necessary?
Dr. Hussong: So when we think about some of the common laboratory tests that are offered as part of an annual physical exam or for a specialized sort of inquiry into patient's health, there probably are some that we should think about that really should be done once a year. And these would include the complete blood count or CBC, the chemistry panel, even though it can be a limited chemistry panel or metabolic panel as some people may refer to it, as well as urinalysis or UA. Those are the ones that we probably should be thinking about as just sort of routine annual tests. There may be a number of other tests that the physician may want to order to address a specific problem that the patient may have, but as a part of the screening test those are the ones that we want to be thinking about.
Dr. Miller: What in those laboratory studies do you think that we might be looking for that would be important for the patient?
Dr. Hussong: Sure. So when we're thinking about a complete blood count or CBC, we're really looking at it to see if the patient may have anemia, for one, to see if the red blood cell count is adequate or potentially even decreased or increased. We also might look at the white blood cell count, which may be an indication of infection that may be going on or an indication of possibly a leukemic process that could be going on. Some patients will present with low platelet counts, which could be an indication or reason why they're experiencing increased bruising as they might see.
Other things that we see with the metabolic panel or the chemistry panel is things evaluating kidney function such as the BUN or creatinine. We also will monitor glucose as a screen for diabetes and then a number of the other biochemical electrolyte like things such as sodium and chloride.
Dr. Miller: Certainly important when patients have any of these illnesses, but I think what you're saying is that a person who feels very well may have some of these abnormalities, which could be an indication that there is early disease that they might begin to have treated or respond to in a way that would prevent it from being a bigger problem down the road.
Dr. Hussong: Exactly. And this is really just a small number of tests that we use to screen for some sort of wider range of problems that the patient may be having. It's really sort of a truncated panel of all the different types of tests that the physician could order, but really allows us to get a global sense of the overall health of the patient during their physical examination.
Dr. Miller: Now these time-honored tests, and I've ordered them myself and I continue to do so, basically are not terribly expensive. Is that correct?
Dr. Hussong: The tests that we were talking about just now, they're very inexpensive and I think that's important for the patients to realize. There are lots of specialized, newer tests that are out that can cost up to thousands of dollars, but these are very inexpensive tests that can provide a lot of information to the treating physician.
Dr. Miller: And how about a thyroid test? We sometimes order that if we suspect the patient may have a thyroid disorder if they're fatigued or if there's a sudden gain in weight. Do you think that's a useful screening test or should we just maybe order that when there are indications to do on the clinical exam?
Dr. Hussong: I don't think it's a great screening test just overall if someone doesn't have any signs or symptoms that indicate any thyroid disease. I think if there is worry for that it's important to go through sort of a stepwise process ordering a TSH, for instance, to start with and maybe a T4 but not to go to some of the specialized tests for thyroid function analysis unless you have a real indication and have some of these preliminary test results back first.
Dr. Miller: Great. Now the other thing is patients sometimes forget to ask and physicians sometimes forget to tell them whether they need to be fasting for these tests. What's your opinion on that for the series of screening tests you mentioned, the CBC, the complete metabolic panel or cholesterol panel?
Dr. Hussong: So not for these tests, but there are a number of tests that we do in the pathology laboratory that do have special requirements as you say whether it's fasting or other things that they need to do or certain times of test, times of the day when the blood should be drawn whether it's morning or after a meal and so for these basic tests there is no specific requirements to be thinking about to have these routine tests done.
Dr. Miller: What about the cholesterol panel? Sometimes I'll tell people to fast for the cholesterol panel.
Dr. Hussong: It's probably a good idea. You want to get a real indication as far as where the patient sits in regard to their cholesterol levels but, at the same time, you don't want them to just have had a huge meal that may artificially elevate their cholesterol.
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updated: November 20, 2018
originally published: July 7, 2015