Manual Assessment vs. Blood work

We seem to have collective misconceptions about findings in blood work or imaging.  Firstly, that we have fool-proof means by which we can test for every known condition. 

Secondly, that if and when something is found, it definitively pinpoints the problem. 

Thirdly – that these more ‘advanced’ methods of testing are superior to what can be assessed by plain observation and physical examination.

We want to believe there is a guarantee on the accuracy and reliability of our health care system.  This does not exist.

Don’t get me wrong, I am not opposed to diagnostic imaging or blood work.  Everything can be useful and I, myself go in for routine blood work.  But we should not discard what we have readily available, that has a history and track record and that can offer profound insight.  When I want an in-depth understanding of the patterns present along with the overall and most pressing issues, I turn to physical exam.


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  • So-called “Liver Function Tests”, do not actually check for the functioning of the liver.
  • Some hormones are best checked at particular times of the day (.e.g TSH for thyroid)
  • Some hormones are almost never checked, even when indicated (e.g. insulin).
  • There are hundred of hormones, and millions of molecules in the human body.  Some are transient, we literally cannot test for everything.
  • Consider the difference between deductive thinking and reductive reasoning and you will see the difference between labs and physical exam.

Blood Work vs. Physical Exam

I am a huge proponent of performing a thorough, old-fashioned physical exam.  And I take it one (or two) step(s) further.

  1. Blood work and imaging can all be found normal despite there being a dysfunction easily found on physical exam.  I’ve seen this many times when I find a thyroid tumor or growth on a person with otherwise perfectly normal labs.
  2. I perform a subtle physical exam where I check for functional movement relative to a particular tissue.  Function leads to assessment and assessment provides options for treatment.
  3. Blood work checks for frank disease and is a means to diagnose.  Diagnosis dictates treatment.
  4. When something shows up on blood work, it means the underlying process has been going on for some time.  Blood work will catch things, but often when past the point of being easily reversible.
  5. The hands are several times more visually acute than the eyes.  For a trained and experience practitioner, the hands provide a visual interpretation of what is actually present.
  6. The hands provide qualitative and quantitative measurements: size, shape, firmness, flexibility, movement, mobility, motility, vigour and more. Whereas, blood work provides one number which is then compared to an average; and an image provides a snapshot that needs to be interpreted without the benefit of knowing texture, mobility, flexibility, energy or motility.

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