“Your wife has gestational diabetes.” My heart stopped when my wife’s physician called to tell me this. “I want you to tell her because it’ll be easier to give it some time and let it sink in. Tell her to call me if she has any questions.” But I had questions — about a million.
Let me give some background information. I’m a third-year resident physician at a family medicine residency program. My wife’s physician is a fantastic physician; he’s one of my attendings, one of my mentors. I’ve taken care of plenty of gestational diabetes during training, often with my wife’s physician as my supervisory physician.
But my wife is the epitome of health. She has run multiple half-marathons, she doesn’t drink sodas, she watches her weight, she drinks over a liter of water a day. She rarely eats sweets, limits her breads, and she was 5’7, 130 lbs prior to pregnancy. She’s 29 years old. She has no family history of diabetes. So if she has gestational diabetes, what else could be wrong? She’s obviously not as healthy as we all thought.
And so it began. I picked up a glucometer for her. We started checking her blood glucose. But something didn’t seem quite right. Her blood glucose measurements were amazing. It was ridiculous how good they were. My wife kept asking me questions — prior to this diagnosis, she thought she was healthy. She asked me what I thought was wrong with her. She asked me why her blood glucose seemed to be normal with the machine — was the glucometer broken? I discussed it with my friends, they all comforted me, said things like, “As long as the baby’s healthy, none of this will matter.” I’d talk about her normal glucose measurements, and they would say things like, “Good — tell her good job with her diabetes!”
I fought for her to get tested again. Turns out she doesn’t have gestational diabetes — not even close. In fact, her fasting blood glucose was actually flagged for being low. She’s as healthy as she initially thought. But for the time between the two tests, she questioned everything about her health.
We love tests — we’re a country enthralled with medical technology. With this love of tests comes the risk for false positives. That’s what my wife had. And they’re not uncommon. But what if she had a false positive mammogram leading to an unnecessary surgery? What if she would have developed a pulmonary embolism after that unnecessary surgery? The results of false positive screening tests can be catastrophic.
I’m not sure what the answer is. I do, however, know that screening low-risk individuals for a condition increases your risks for false positive test results. So maybe physicians need to risk stratify better. But, that would result in a lot more talking and a lot less testing: the exact opposite of where our medical world is headed.
Justin Reno is a family medicine resident.
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