“But Dr., I've already had complete examinations with other health professionals and everything was normal. So what have I got? Do I really have a disorder?”
1 - If a person complains of a problem, it is clear that there is a disorder. If it's not organic, it could be psychiatric in nature, manifesting itself in a preoccupation with a condition that the person believes they have. Do you agree?
2 - Each health professional requests the tests they consider necessary. In other words, what one professional considers to be a “complete” examination may not include several others that another professional would request. Every human being has their own way of thinking, their own opinions and approaches to everything, and health professionals are no exception. Therefore, what is “complete” for one professional may be considered incomplete for others.
3 - What does a “normal” test result mean?
“Normal”, “acceptable”, “reference”, “altered”, “ideal” and “desirable” are different concepts in clinical practice, many of them subjective. Let's explore these terms in general terms:
- O reference value of a test is the one reported by the laboratory in the report, such as a man's ferritin, which should vary from 29 to 300 ng/ml.
- Normal is what each professional considers not to be the cause or aggravation of the patient's complaints.
- Acceptable is a result that is not exactly what the professional would like, but which he considers “passable” for the case in question, deserving only observation and future monitoring.
- Desirable is the result that the professional wants for their patient.
- Ideal is the outcome considered to be the most beneficial for the patient's health, in the opinion of the health professional.
- Amended is a value for the test that the professional deems abnormal, even if it is within the reference values.
Let's take the example of DHEA hormone dosage:
The SDHEA reference value for women ranges from 34 to 430 mcg/dl in a good laboratory in the Federal District. Depending on the patient's complaints, I consider values between 100 and 200 to be acceptable, but I usually consider values between 200 and 400 to be desirable, with the ideal being around 300.
4 - Laboratories have values and units that can vary from one establishment to another, which makes it difficult to compare different results. In addition, there are laboratories with different levels of quality in procedures, methodologies and equipment, and all these factors affect the quality and reliability of the final result obtained.
5 - Many exams require specific conditions, such as food beforehand and adequate time and rest. They can also be affected by medications and supplements being used. In these cases, it is clear that the patient themselves can inadvertently jeopardize the reliability of their tests.
Got it? In short, the same test result can be interpreted in different ways by different professionals, depending on their individual concepts, studies, skills and parameters!
Finally, about complementary exams, complement your study by reading on:
http://icaro.med.br/exames-complementares-o-que-e-importante-levar-em-consideracao/
What about the doctors who order more tests, are they less or more competent than the others?
Have a good week!
Português do Brasil 
English 