Mrs Green aged 60 comes complaining that she feels fatigued and tired, although there are no specific symptoms and she has no fever, pain, bowel upset, bleeding, nor any mental health symptoms. She is sleeping normally and doing all her usual activities easily, and working full time. She is happily married and has no children by choice. She is not clinically anaemic, chest and abdominal exam is normal. Her doctor does “some tests” FBC CRP E and E LFT GGT coeliac screen TFT, B12 folate serum iron, HBa1c, Vitamin D urinalysis myeloma screen HIV hepatitis screen and ends up with about 25 (maybe even 30 or 40??) results to digest and interpret. The serum phosphate is a little low, the sodium is 134 (NR 135–146 mmol/L) the HGBA1C is 38, risen from 32 last year at a “health check” The patient sees the results as she has direct access to her electronic record and rings up saying “What do I need to do about these abnormal results and what tests should I do next? Why did you do an HIV test are you saying I am promiscuous? Can I have a whole-body scan to see what’s wrong?” It says on google I have got pre diabetes!

1) Your results may vary: the imprecision of medical measurements

BMJ 2020; 368 doi: https://doi.org/10.1136/bmj.m149