Testing wisely

Testing wisely: Support for communication with patients who request tests that are strongly recommended against

When a patient asks for a test that is strongly recommended against: Align, Acknowledge, Re-focus

• Align: Hear them out and listen. Try to elicit the reason(s) for their request.
• Acknowledge: Reiterate their concerns and priorities.
• Re-focus priorities: Explain why the Task Force strongly recommends against this test and explain that focusing on more pressing health issues (if relevant) should be the priority.

Conversation with a patient using thyroid screening as an example

Patient

I read about thyroid screening and I would like to be tested. 

Clinician

May I ask why you’re concerned about your thyroid? 

Patient

Well it runs in my family so that worries me. 

Clinician

OK I can understand why you might be concerned. However, the Canadian Task Force recommends strongly against screening for low thyroid. So because of your (age/health history, and lack of symptoms etc.) I think it’s best if we focus on more pressing health issues that you may have. 

Patient

But if I can find the problem early, before it gets bad, I would like to deal with it. 

Clinician

I understand your thinking. But screening people without overt symptoms leads to unnecessary treatment. This could mean medication for the rest of your life, frequent visits to a lab for blood tests, and extra costs.

If the patient still requests the test:

• Offer a decision aid or patient education tool (if available).
• Clarify any questions or misconceptions they may have.

Example conversation with a patient

Clinician

I understand that testing was more common in the past but as time goes on new studies and evidence can change practice. Being tested for thyroid function at this time won’t improve your health, in the long run. 

*If patient tool is available* Take a look at this tool, which provides some more background information and helps explain why the testing isn’t recommended. Then, let me know if you have any questions.

If the patient still requests the test:

• Explain that patient-centred care involves avoiding harm and wise use of resources that confer benefit.

Example conversation with a patient

Patient 

I understand that there are potential harms for this screening test but I would still like to get it done. I would just feel better knowing. I’ll take the risk. 

Clinician 

Putting you at the centre of care involves helping you to avoid harms. Screening for this disease without a good reason (no risk factors, no symptoms) can lead to over-diagnosis and over-treatment as mentioned. 

It can lead to you being treated for something that isn’t actually a problem.