In my clinical work, I often encounter a very interesting phenomenon: patients often consider tests with negative results as unnecessary tests, and consider them as indiscriminate tests prescribed by doctors. I once met a patient who angrily asked me: “Why did you prescribe this test, look, the test results came out fine, you are clearly wasting the patient’s money by prescribing tests? At that moment, I really wanted to cry… There is a famous line in Shakespeare’s famous play: Tobe, or not to be – that is the question (survival or destruction, that is the question), which reflects the tangled inner conflict of the main character in the play. In fact, doctors often face a similar dilemma in the practice of medicine: to examine or not to examine, that is the question. Mr. Ling, a young man in his early 30s, had been experiencing recurrent lower back pain for the past six months. During the consultation, I learned that Mr. Ling’s lower back pain mostly occurred in the morning when he woke up, and sometimes there was a little stiffness in his lower back, and the pain would be relieved after moving around. I then did a physical examination for Mr. Ling and found that his spinal mobility was normal and there was no obvious pressure pain in his lower back. One hour later, the x-ray report came back: there were no obvious pathological changes. After reading the report, Mr. Ling seemed relieved and asked me what my professional opinion was. Based on the information at hand, I told Mr. Ling: Regarding your disease, there are two biggest possibilities at the moment: one is a common lumbar strain, and the other is early ankylosing spondylitis. If it is a lumbar strain, it is not a big problem and can usually be cured with conventional treatment. If it is ankylosing spondylitis, it is a chronic disease that can lead to spinal deformity and disability, and the treatment plan for this disease can be very different, requiring long-term medication to control the progression of the disease. In the later stages of ankylosing spondylitis, there are characteristic changes in the x-ray of the lumbar spine, but your current x-ray does not show those changes, but you still cannot rule out the possibility of ankylosing spondylitis because the early lesions of this disease can only be detected by MRI or CT, not by x-ray alone. The early detection of ankylosing spondylitis has a very positive impact on the outcome of treatment, and if the diagnosis is delayed until the middle or late stages, the treatment will only be half-hearted. Looking at a confused Mr. Ling, I continued: My suggestion is to do an MRI (magnetic resonance imaging), because the cost of this project is more expensive, 800 yuan, so you can think about it yourself before making a decision. Although at this point in time, based on personal experience, I estimate that the likelihood of you having ankylosing spondylitis is less than 15%. But this disease is different from lumbar strain, if you really have it and do not have timely diagnosis and targeted treatment, it can be disabling. So you should seriously consider whether to have further MR exams or not. This is a typical situation about whether a certain test should be done or not. Mr. Ling’s situation is actually: facing the possibility of a disabling disease (I predicted at the time that he was less than 15% likely to have this disease), as a patient, he was willing to go for further tests, and the cost of the related tests was relatively expensive. In fact, different patients may have different choices about this. Essentially, it is a question of “how much risk are you willing to take by not having a certain test done?” It’s a question of “How much risk are you willing to take by not getting a certain test? Because even though I’m a doctor, and even though I’ve seen a lot of patients with ankylosing spondylitis in my practice, it’s still impossible for me to say to this Mr. Ling: If you get this expensive MRI done, I can guarantee that the test will be positive and confirm that you have the disease. If I can 100% assert whether the result is negative or positive before doing a test, I don’t need the patient to pay for the test, then I am a god:) The hospital doesn’t even need to allocate so many testing instruments, it would be much easier to hire me as the head of the testing department. It is because the doctor in the diagnosis and treatment with uncertainty and doubts to consider, will be prescribed for the patient’s checklist, rather than like some charlatans as a matter of faith. Back to Mr. Ling’s side: After my patient explanation, Mr. Ling decided to have the MRI done, even though it cost 800 RMB. The results came back: the scans revealed early characteristic changes of ankylosing spondylitis, so Mr. Ling’s disease was diagnosed – it was early ankylosing spondylitis. Mr. Ling’s disease was later treated well under a specialized treatment plan. Usually, doctors do tests for two purposes: 1) to make a diagnosis; and 2) to evaluate the effectiveness of treatment or to estimate the prognosis of the disease. Theoretically, the more relevant tests done, the smaller the chance of misdiagnosis and the more objective and realistic the assessment of the disease. However, too many tests may involve cost and time issues. Like buying a lottery ticket, everyone understands that the more tickets you buy, the better your chances of winning, but the more it costs. Therefore, physicians always try to strike a reasonable balance between the number of tests and the benefits to the patient. As for how to reach a reasonable balance, I think it is more in the healthy communication and negotiation between doctors and patients, like the above exchange between me and Mr. Ling is a positive example.