By Admin | August 06, 2012
By Robin Shah, DO, MBA
Robin Shah, DO, MBA, is an internal medicine resident at The Christ Hospital in Cincinnati, Ohio.
Have you ever ordered a test without really knowing how to interpret it or how the test results would affect management of a patient’s care? In this age of technology, we all have ordered tests per “protocol” or because the order set that we used included it. It’s very easy to follow the protocols that are standardized for all patients. However, as physicians, we are trained to evaluate what the appropriate tests are and gear our care toward the individual patient.
My article in the July 2012 issue of Federal Practitioner, Elevated Cardiac Troponins–Not Always an Acute Coronary Syndrome, explains that cardiac enzymes, such as troponins, are a very sensitive laboratory test. In the Emergency Department, most patients with chest pain, shortness of breath, and associated symptoms are tested for elevated cardiac enzymes. However, when interpreting the test, it is important to remember that these enzymes are elevated when there is myocardial cell injury, but does not determine the mechanism of injury. The article discusses that there are many common causes of a cardiac troponin leak.
As I continue my training as a physician in residency, I realize it’s easy to fall into the routine of ordering tests, even for the sake of our education. In our training, it is also emphasized that before we order any test, we establish a differential diagnosis and relate each test to that. This way, our tests become more meaningful, and we can minimize unnecessary testing. At times, it may feel inefficient, but I hope that over time, my thinking process can follow this logic to make my way of practicing medicine most efficient.