The Offending Statement
"My child is tired and achy; can you just send off a Lyme test? Can you do bloodwork for thyroid disease?"
Whoa, whoa, whoa! Slow down there, Mom. If your child has been exhibiting unusual signs of fatigue or illness, it’s natural to be alarmed and begin searching for possible answers, but requesting specific testing and bloodwork is not the way to get to the root of the problem. In fact, it has a major downside. Doctors work through a deliberate method when coming to a specific diagnosis, and shortcutting to the answer poses significant risks.
Why We Don’t Want to Hear It
Doctors take an oath to do no harm. Despite your best intentions, requesting specific screenings without a process behind them may actually cause harm to your child. Being cautious about proceeding with Lyme disease test and thyroid disease bloodwork are just two examples of this medical tenet (for very different reasons):
The Lyme disease test is helpful when used appropriately, but as a general screening test, it tends to produce an enormous number of “false positives.” For this reason, physicians try not to screen patients for Lyme disease unless certain symptoms suggest the illness is present. In certain circumstances—determined by your pediatrician—the test is useful and diagnostic; in others, it is much more likely to result in a false positive than a true positive, thus leading leading your child down the treatment path to an incorrect diagnosis. Imagine giving your child two or more weeks of unnecessary powerful antibiotics and not having her feel any better. Not good!
On the other hand, thyroid bloodwork in children is just plain unnecessary in most cases. If your child is growing normally (something that’s tracked at each annual checkup), there is rarely a reason to suspect that he has a thyroid problem. Low thyroid conditions or "hypothyroidism" always affect linear growth over time, so by plotting a nice interval height gain in a patient, I can often reassure parents and save an unnecessary needle stick at the lab. It also eliminates those pesky lab errors that I then have to chase down with further (unnecessary) bloodwork.
Bottom line: If you ask for specific tests, chances are your doctor may not refuse. But unless the pediatrician actually initiates the testing plan with the advantage of a full history and physical exam, you may be wasting valuable time and resources when you could be directing efforts toward finding the true answer.
What You Should Say
Instead of explicitly requesting tests, present the symptoms and rely on your physician’s expertise in getting to the bottom of the issue. Here's a reasonable approach: “My son has been so tired over the past two weeks. He complains of achy joints and has been taking naps for the first time in years. Help me figure out what is going on."
Bring your child into the doctor’s office and describe all of his symptoms in detail. Some parents find it helpful to take notes as they notice symptoms and bring their observations into the office for discussion with the doctor (for example, you might keep a sleep diary for a child with fatigue). After explaining your concerns, a careful physical exam should follow and then appropriate labwork will be requested and interpreted by your physician.
Helping Parents Deal
In addition to being a pediatrician, I’m a parent. My parenting career started with worries about prenatal screening, evolved to concerns about early infant fussiness, graduated to fretting about recurrent ear infections, transformed to angst over transitioning my child to daycare … and so on. Concerns change with your child’s growth, and seem to get only more complicated over time!
These worries may prompt you to hunt for information, some of which may be good but some of which can also be bad. At some point you need to balance your role as parent and your role as diagnostician (even if you are a medically trained parent!). Find a clinician who listens, who discusses his or her rationale and plan, and whom you trust. A productive parent-clinician relationship and a bit of persistence will solve most medical mysteries. Rarely will the answer be found with a simple blood test.