I may be a doctor, but I have also been a patient more often than I’d like to have been over the last 15 years. Now, I personally don’t think there is anything quite as frustrating as a set of ‘normal’ blood results when you know ‘something isn’t right’.
Many of us have had this experience: we have made the effort to see a doctor, (usually waiting several weeks for an appointment), we spend time explaining our symptoms, within the constraints of a 10 minute NHS consultation, and the clinician suggests doing a few bloods and we’re sent on our way. We then dutifully get our bloods checked, only to be told they are normal and no further action is needed! THE END
Except this shouldn’t be the end, blood tests are only part of the assessment. Any decent GP will look at these results together with the history still in their mind and review their patient. Unfortunately, what we are seeing more and more, due to the failing NHS system, is a lack of continuity of care and patients not always able to get the answers they need.
Many doctors often confuse “normal” blood levels with healthy levels, which is a common misconception since normal does not equate to optimal!
Labs determine blood test results by comparing biomarker levels to a reference range, which is designed to include 95% of the population. This range is established by measuring biomarkers from a representative sample and creating a bell curve, where the upper and lower 2.5% indicate abnormal results. Having now explored how these ranges are determined, it becomes evident that there are several significant issues with relying on reference ranges to determine whether a patient is ‘healthy’ or not.
For example, the ‘normal’ reference ranges for ferritin are 10-350ng/ml. The test shows whether blood has too much or too little iron. However, as doctors, we know that if that level is under 50ng/ml our patient may experience debilitating fatigue, hair loss, dizziness, migraines/headaches. But the lab just told us it was ‘normal’ when it came back at 15mg/ml!
Things are changing and moving in the right direction for some conditions, for example, the guidance for treatment of menopause has changed in the last few years, it is no longer focused on blood results and more about focusing on the issues that the patient is experiencing and treating those symptoms.
I have to say, hormonal blood tests are honestly one of THE most frustrating blood’s to interpret as a doctor, pre-menopause they fluctuate with the cycle (presuming the patient in front of you has a ‘normal’ cycle) and so can look ‘Normal’ when they are anything but! We then come to perimenopause, where these fluctuations can be a daily occurrence and we are literally trying to find a needle in a haystack!
Hopefully, I have not just cured your insomnia with this rather long blog, but I have encouraged you to look a bit more carefully at your results in future, or to make an appointment to discuss ones you have already had done in more detail! I am often presented with patients ‘normal’ results in Revitamed only to find they are not normal at all!
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