You've been dragging around for 10 days feeling achy, fatigued and feverish. You're not sick enough to stay home from work, but not quite well enough to be there. Finally, you give in and make an appointment with your family physician or internist.
Common symptoms like these could be caused by hundreds of diseases: everything from a garden variety cold to mononucleosis. The fatigue part of the equation, depending on your age, might indicate something innocuous such as a mild infection, or something far more serious such as multiple sclerosis or heart disease. If you work outside or have a weekend cabin in the woods, the physician might wonder if your symptoms could be related to Lyme disease.
Some common diagnostic tests your doctor might order:
The human touch
"The most important part of making an accurate diagnosis still revolves around the human touch: the physical and the history," says Stephen Kolesk, MD, family practitioner, president of the Virtua Memorial medical staff. "That's when the physician goes down a mental check list, and starts to include or exclude certain diseases and conditions based on what the patient is presenting."
Physicians view the body in terms of its different systems. When a patient comes in with a complaint of fatigue, the physician thinks: Is the problem related to something in the person's cardiovascular or respiratory system, musculoskeletal system, the neurological system or the gastrointestinal system which consists of the liver, kidneys, stomach, and spleen?
For example, a man over age 40 or a woman over 50 who has been complaining of chronic fatigue may require an echocardiogram, a test which studies the structure of the heart and how it is functioning, as well as a complete blood count (CBC), among other tests.
Don't think it's a zebra
David Zalut, MD, family physician says: "Medical students learn early on that 'when you hear footsteps, don't think it is a zebra,' meaning that when a patient comes into the office complaining of fatigue, most individuals simply have a common illness, such as a cold and only a rare few have something truly life-threatening." However, if a patient's symptoms persist, the physician will order the appropriate tests to rule out all possibilities, even the most remote.
Sometimes, one test may only open more avenues of exploration. A person who goes to the doctor with a chronic cough will, no doubt, have to get a chest x-ray. If the x-ray reveals a shadow or a spot on a lung, the doctor will probably order a more sensitive test such as a CT or PET scan, or even a biopsy. "The astute physician is always asking, what else can I be doing for this patient?" says Dr. Kolesk.
Diagnostic or screening
Tests fall into two basic categories: screening tests to learn if a person has a disease when generally no symptoms are present. And, there are diagnostic tests – when a doctor suspects that someone has a specific disease and wants to confirm the diagnosis. When you or someone in your family is not feeling well, your first line of defense is to make an appointment with your family practitioner or internist. For a Virtua physician, call toll-free 1-888-Virtua-3 (1-888-847-8823).
Some common diagnostic tests your doctor might order:
Complete blood count (CBC): A blood test that evaluates the total composition of the blood: red cells, white cells and platelets. For instance, a too-high white blood cell count may indicate infection, while a low red count may indicate that not enough oxygen is getting to the organs of the body.
Chemistry profile, also called a chem screen or a sequential multiple analyzer (SMA): A series of blood tests which analyze and monitor the proteins, enzymes, electrolytes and chemical compounds in the body, indicating how various organs are functioning, among them the kidneys, liver and heart.
Computerized tomography (CT scan): A series of x-ray images that examine sections of the body in three-dimensional "slices."
Electrocardiogram (EKG): A non-invasive test that monitors the heart's electrical activity.
Electroencephalography (EEG): A non-invasive test that monitors the brain's electrical activity.
Magnetic Resonance Imaging (MRI): A test that uses magnetism and radio waves to create images of the internal body, including head, spine, heart, lungs, abdomen, pelvic area and musculoskeletal system.
Positron emission tomography (PET scan): A test that creates images of many different metabolic functions in the body and is highly sensitive for certain types of cancer diagnosis and follow-up treatment.
Prostate Specific Antigen (PSA): A blood test that measures the levels of prostate specific antigen, which may indicate prostate cancer.
Thyroid panel (TSH): A blood test that checks the levels of thyroid stimulating hormone to determine the presence of hyperthyroid or hypothyroid conditions.
X-ray: A two-dimensional image of a segment of the body.