The Doctor Isn't Always Right

Research published in the Annals of Internal Medicine found that many doctors recommend a less-accurate in-office test rather than the recommended (more accurate) take-home test for colorectal cancer.

In-Office FOBT vs. Take-Home FOBT

The report, "A National Survey of Primary Care Physicians' Methods for Screening for Fecal Occult Blood," found that 33% of physicians who had ordered or performed fecal occult blood tests (FOBT) chose the in-office test over the take-home test.

This is despite the fact that national guidelines recommend the home test over the in-office test. Research has also shown that the home test is better at detecting polyps than the in-office test. So the question, then, is why? Why do so many physicians order the less-effective, unrecommended test? If your doctor does so, that would be a good question to ask.

Sigmoidoscopy vs. Colonoscopy

The study also found that almost a third of doctors weren't performing the recommended test when a patient had a positive FOBT. National guidelines recommend a colonoscopy (which takes a look at the entire colon).

However, a significant portion of doctors performed a sigmoidoscopy, which only examines part of the colon. Again, why? Why do so many physicians perform the less-thorough, unrecommended test? If your doctor does so, you should ask.

Remember: Doctors Aren't Demigods

Doctors aren't always right. They know a whole hell of a lot, there's no contesting that. But people who really know what they're talking about won't mind explaining it to you. So ask. Ask, ask, ask:

• I read that the home test is more effective. Why are you recommending the in-office test?
  
  
• I read that doctors are supposed to do a colonoscopy when the FOBT is positive. Why are you recommending a sigmoidoscopy?

There's nothing wrong with asking. It's not challenging your doc's authority. You're equals. If anyone has authority, it's you. You're the patient, the consumer. Ask. There may be a perfectly good explanation. Then again, there might not.

Sources:

1. Colorectal Cancer Screening among Adults Aged 50 or Older: Implementation of Fecal Occult Blood Testing in Clinical Practice. NCI Cancer Advocates E-News. 21 Jan. 2005.
   
2. Nadel, M. and Shapiro, J. "A National Survey of Primary Care Physicians' Methods for Screening for Fecal Occult Blood." Annals of Internal Medicine 142.2 (Jan. 2005): 86-94. 25 Aug. 2006 [http://www.annals.org/cgi/content/abstract/142/2/86].