Sometimes listening works better than testing

Blood tests may not be necessary to address patient anxiety about unexplained symptoms that are likely to resolve on their own.

By Victoria Stagg Elliott — Posted March 31, 2009

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Talking to a physician is more effective than a blood test at increasing patients' satisfaction with the visit and decreasing their anxiety about symptoms that have no known cause, according to a study in the March/April Annals of Family Medicine (link).

"Primary care physicians overestimate the effects of blood test ordering in patients with unexplained complaints of recent onset. They underestimate how much they themselves can contribute to the well-being of their patients by discussing their worries," said Dr. Marloes A. van Bokhoven, the study's lead author and a family physician at Maastricht University in the Netherlands.

Researchers followed 498 patients seeking care from one of 63 primary care physicians for fatigue, abdominal discomfort, musculoskeletal pain, weight changes or itching. For some patients for whom no explanation for the symptoms could be found, a blood test was immediately ordered. For the others, four weeks of watchful waiting was initiated with additional medical work-up if symptoms did not resolve. Those who most felt physicians took them seriously and did not dismiss their complaints were more likely to be satisfied with the care received. They also had lower levels of anxiety. Whether a test was ordered made no difference to these issues, and the authors suggest a watchful waiting strategy may reduce health care costs and improve patient care.

"Because 90% of initially unexplained complaints are self limiting ... a watchful waiting approach may dramatically reduce the number of patients who need to be tested. This strategy prevents uncomfortable blood drawing from patients. In addition, it may prevent a relatively large percentage of false-positive test results," wrote Dr. van Bokhoven.

Patient-physician communication experts complimented this paper for documenting the positive effect of a doctor's words.

"It's somewhat of a myth among doctors that we have to order a test to satisfy a patient," said William Branch, MD, director of general internal medicine at Emory University School of Medicine and immediate past president of the American Academy on Communication in Healthcare. "First build a relationship. Then decide about ordering the test."

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