All Your Tests Are Negative. Now What? - A Lesson On Thinking A Step Ahead

You’ve ordered a slew of tests for your patient. You hope that one of them comes back positive, giving you guidance for the next step in the patient's care. However, your tests all come back negative, leaving you wondering what to do next.

This is a common scenario whether you work inpatient, outpatient, or a combination of both.

Most of the time, it’s easy to know what to do if the tests are positive. It’s much harder to decide what to do if the tests are negative.

We cannot discuss every single scenario, but it’s important to bring up the following concept:

When you order a test, consider what you will do if the result is negative.

Do this and you find yourself one step ahead in many clinical scenarios.

Ask yourself questions like:

·         Should I expand my differential diagnosis?

o   If so, what other diagnoses should I check for?

o   If not, am I sure that I have enough information to proceed with treatment?

·         If I need more information, how will I get it?

o   More tests? more History? More physical exams?

Experienced physicians often get to the point that they internalize these processes. However, even experienced physicians can still get stuck when they unexpectedly get negative test results. To be more ready to adapt to these situations, it is good practice for all physicians, from brand new to well-seasoned, to  explicitly ask themselves what their next step will be if the tests they order are negative.

Clinical practice is a tricky thing, and events do not follow the textbooks and guidelines. If you think a step ahead and plan out the next steps for when your tests are negative, you will be more ready when your tests results are unexpectedly negative.

If you are interested in learning more about this and other topics in clinical decision making, check out my book A Guide to Clinical Decision Making.