DO WE NEED 'TESTS' FOR DIAGNOSIS

      We in medicine have seen pendulum swinging from one end to other in many aspects of medicine. We have seen popularity of different tests or treatments . With time we may have n=better tests or the tests becomes less reliable with more tests being done. CT scan or PET scans can be considered belonging to this category. When the PET SCAN came in we thought that it was going to be 100%  accurate in getting diagnosis of cancer. But as more and more tests were done and we gained more understanding in to the tests, we realized that the accuracy of getting diagnosis of cancer , was reduced and not closer to 100%.But now we know that it's close to 85% . But sometimes things that we assume based on history and physical examination, are not 100% and we need additional information . Sometimes we order tests to confirm our suspicion  and then we are surprised. That brings me to story for today.

       I saw this 60 years old male who came to me for shortness of breath. This was going on for years  and he has seen new PCP and he had sent him to cardiologist .He was nonsmoker  and had history of high blood pressure and mild diabetes. The cardiologist di the work up and the work up did  not reveal any cardiac problem and he came to me. He had shortness of breath for long time. His physical examination was unremarkable. His lungs were clear and he had good oxygen saturation. He was obese  and may have had sleep apnea, but that was not related to his current problem or complaints. I thought that he had increased BMI  and overweight had caused decreased activity and exercise  and so he was DECONDITIONED . So the shortness of breath was due to that, especially as cardiac problems were ruled out . But I was going to do the work up . My presumption was that the work up will be good  and then I can tell him on weight and lack of exercise and shortness of breath. 

    I did do the pulmonary function studies  and to my surprise he had moderate obstruction - indicating ASTHMA . So even though he had shortness of breath for long time and the lungs were clear  and oxygen was fine - he had asthma .So sometimes we need TESTS to diagnose !!