I received a phone call from an irate patient today. Apparently he took exception to a chromosome report I had authorised. We never issue reports directly to patients however, patients have a legal right to their medical notes including laboratory results and therefore are allowed to pester their doctor for a copy. Genetic reports are rather specialised, resplendent with technical notation and well larded with scientific jargon. Like most professionals we take great pride in keeping lay folk ignorant and in awe. Consequently most people struggle with our arcane scribblings. Even experienced clinicians require advice and further interpretation from a geneticist, on occasion. The wise patient is advised to seek specialist help from a clinical geneticist trained to interpret the scientist's endeavour, but not all patients are wise or even patient.
The report in question was relatively simple and uncontroversial and there was little in it to raise ire in most folk. The offending item: We are unable to exclude the presence of subtle chromosome abnormalities. Bland and innocuous enough I thought. However, the patient had seized on our usual caveat, ran it up the flag pole and concluded that they were afflicted with a subtle, unique and occult chromosome abnormality. I tried to explain that this was just a standard ‘rider’ we place on normal reports and in no way implies that the patient has a genetic abnormality. I did consider mentioning that all diagnostic tests are subject to inherent limitations, and in this instance, chromosomal analysis was not really warranted as the patient was suffering from anxiety, well at least according to the referral form. In fact, as far as I’m aware, there is no genetic test available for anxiety. If indeed the condition has a genetic basis it is highly likely that the genetics involved are complex, convoluted and subtle with a hefty dose of environmental factors dumped into the turbulent mix. Wisely I held my counsel. Inwardly I wondered why a competent physician would have referred a patient with ‘anxiety’ for chromosome testing, but as the patient continued to rave I was starting to guess. I suspect that the harried doctor had simply ordered the test to placate his patient. Chromosomal testing looks fancy and genetics is perceived as a powerful tool for solving everything these days. I sympathised with the poor doc. An awkward patient mollified with a procedural placebo, or perhaps not in this case. Feed a mad person and you just end up with a fatter mad person.
I blame the media and the internet. The media has seized on the ‘new genetics’. Clever scientists can now diagnose and cure all that ails us. A brave New World is about to descend and envelope all (not gypos though) in a cacoon of soft light and wonderment. Everything will be tainted with a clinical freshness and rich old white men will live forever (? surely some mistake). And then there is the netty phenomenon, where any halfwit can trawl the web to garner information on anything. Information of variable quality and dubious provenance impinges on third class minds to the detriment to all within hailing distance. The devil is not in the information itself but how we sift it and ultimately how we interpret it.
My caller had now moved on to explaining how the government had cloned an invincible army of soldiers which were about to be unleashed on the
Middle East. My mind started to
wander/wonder and I began to sketch out on my notepad an archetypal invincible
cloned soldier. When I finished I noticed a distinct resemblance to my good
self, even down to the third nipple and noble brow. My mind was meandering and
I was no longer listening to the caller’s rant until he mentioned something
about mice with human ears attached to their backs. Feeling mischievous I
intervened and said this research was geared toward curing deafness in mice. I
thought this was a suitable juncture to put down the phone. I’m hoping that the
termination of our conversation would act as a prompt for the caller to partake
of his appropriate medication and in the correct dose. I was certainly ready
|Look, I've invented an ashtray with a built in 'eep'|