pureheart

Medical Test Results: Are You Normal, And Is That A Good Thing?

Jan. 27, 2004

By Robert H. Shmerling, M.D. Beth Israel Deaconess Medical Center

* "Everything Is Fine"
* When Something's Amiss
* When "Normal" Is Not Good
* Knowing The Limitations Of Testing
* The Bottom Line

When doctors talk shop, they often use terms to describe an examination
or test result by comparing it to "normal." While this might seem
straightforward, health-care providers use a number of expressions that
might confuse you if you aren't prepared. Read on to learn how to
interpret what your doctor is saying when he or she sends you a note,
calls you or talks with you in the office about the results of your
evaluation.

"Everything Is Fine"

Fortunately, in the majority of doctors' practices, the most frequent
result of an examination or testing is "normal." I recall having a
throat culture performed at the college infirmary; when I stopped by to
get the results, the physician simply pointed to the actual report from
the laboratory: It read "Negative" in bold letters. That worried me,
because I thought that "negative" meant something bad and that a
positive result was a good thing. In fact, when reading medical
results, it's usually the opposite; with rare exception, "negative"
is normal (because it means that an abnormal result is not present) and
"positive" is abnormal or unusual (because it means that something out
of the ordinary is present).

There are a number of ways health-care providers express normalcy.
These include:

* Within normal limits ("wnl") - Many test results have cutoffs above
which the result is too high and below which the result is too low.
Usually, these cutoffs are established by measuring the test in normal,
healthy people (called "a reference group") and figuring out where 95
percent of the results fall; if your result falls in between the
cutoffs, your health-care provider may call it "wnl," "in the normal
range" or "within the reference range."

* Unremarkable - An unremarkable result means that it is much like
other, normal results. Generally, that's a good situation. It's
usually good not to be too "interesting" when it comes to your health,
so hearing that your result is unremarkable should not be taken to mean
that your doctor is not interested or impressed with you!

* Unimpressive - As above, this term implies that if there is any
abnormality detected, it is minimal or insignificant.

* Nonfocal, or, no focal abnormalities - These terms rely on the
finding that in the human body, there is often symmetry between the
right and left sides and there is uniformity in the makeup of many
organs. If there is a "focal" finding, it indicates a localized
abnormality where none should exist; examples include a difference in
the knee reflexes, or a spot on a chest X-ray where usually the lung
appears uniform. "Nonfocal" findings usually indicate the absence of
such an abnormality.

* Intact - This is used to indicate that something that should be
present is in fact present. Examples include pulses or reflexes.

* Non-pathologic, benign - Some serious abnormalities have features
that distinguish them from unimportant ones. For example, lymph nodes
may enlarge to a certain point in healthy people, but above a certain
size could indicate cancer or other problems. If a CT scan reveals
slightly enlarged lymph nodes that otherwise appear normal, the report
may describe them as "benign-appearing" or "non-pathologic," indicating
the likelihood that they are not an indicator of cancer or other
serious illness.

* Insignificant - This term is often used in the usual way, to
describe a finding that may be minimally abnormal or abnormal in an
unimportant way (for example, as a freckle on the skin). Another way
this term is used is as a statistical measure regarding the likelihood
that an abnormal finding is "truly abnormal" or "abnormal due to
chance." When the findings are mathematically estimated to occur just
as a matter of chance, the results may be termed "insignificant."

* Stable - This indicates that the result is similar to previous
findings; while it may not technically be normal, if it is not changing
over time, at least the abnormality is not worsening. Such a finding
generally provides some measure of reassurance.

When Something's Amiss

Frequently, when the results of an examination or a test are not
normal, the abnormality is minor and has little or no bearing on your
health. So, health-care providers have a number of ways to express a
result that is not normal, but often provide descriptive detail to
specify just how abnormal or concerning it is.

For some tests, such as blood counts, the result is high, low or
normal. For others, such as an X-ray, results may show an abnormality
of little importance, such as a speck of calcium in the lungs or
scarring from past pneumonia. It is not rare that the importance of an
abnormality is not known right away and that more testing or the
passage of time is needed to know for sure how meaningful it is.
Examples of ways an abnormal examination or test results might be
expressed by a health-care provider include:

* Elevated/increased/high - For example, the white-blood-cell count
may be elevated in people with infection.

* Depressed/decreased/low - For example, anemia is defined by having
a reduced number of red blood cells. Blood pressure and hormone levels
are other common examples of results that are typically expressed as
high, low or normal.

* Minimal, mild, moderate, marked, severe - Any abnormality may be
described in terms of how abnormal it is. For example, X-rays may
indicate mild joint disease even in persons without symptoms; such
findings are common in people over the age of 50 even if the joints
feel fine. However, severe joint disease on an X-ray is less commonly
seen in people whose joints feel fine, so the severity of the
abnormality on an X-ray is typically described by radiologists in these
terms.

* Uncertain significance - Because tests have not been evaluated in
every conceivable situation, their results may be abnormal but the
importance of the finding is not completely understood. A good example
of this type of finding is the magnetic resonance imaging (MRI) test.
When it first became available, spots were observed in the brains of
many normal people (in fact, they were often referred to as
"unidentified bright objects" or UBOs, because they appeared lighter
than normal brain tissue). Such findings are common for many tests,
particularly those that display images of the body.

When "Normal" Is Not Good

There are times when a result that is out of the normal range is a good
thing and what is usually considered "normal" is bad. For example, if
you are taking the blood thinner warfarin (Coumadin), the test that
measures blood clotting, (called the International Normalized Ratio, or
INR) should be elevated; it indicates that clotting of the blood is
less likely, a good thing for people who have had problems with blood
clots. Getting the blood "thinner" and less likely to clot is the
reason people take warfarin. While the urgency depends on the reason
you are taking warfarin, a normal result is not a good result; it
indicates that the medication is not thinning the blood enough. Another
example is a pregnancy test; if you are trying to become pregnant, a
"positive" result (indicating that you are pregnant) is a good thing
and a negative result may be cause for disappointment.

Knowing The Limitations Of Testing

A key part of understanding one's test results is knowing what the
test is supposed to do. When I learned that my throat culture was
"negative," that only meant I was less likely to have strep throat.
There was still a small chance I had strep infection (because the test
isn't perfect), and I could still have a number of other causes of a
sore throat, such as a viral infection or even a bacterial infection
other than strep. The test did not mean I was healthy; it could only
help to make one diagnosis (strep throat) more or less likely. Asking
your doctor about the purpose of your tests may help you to understand
their results.

The Bottom Line

The real significance of any particular test result depends on a number
of factors, including why it was ordered, what is normal or usual for
you, whether the test result is getting better or worse, whether you
are getting better or worse, how abnormal it is, and whether it may
even represent an error in the test (rather than disease in you).

But, don't be disappointed if your examination is "unimpressive" or
your test results are "unremarkable." When you are under medical
evaluation, those findings are often the best you can have. On the
other hand, if your results are abnormal, do not panic; your doctor
cannot be positive that your positive results indicate a negative
health outcome. Sometimes the most difficult part about getting your
results is figuring out what your doctor is saying.

http://www.intelihealth.com/IH/ihtIH/EMIHC267/9273/35328/375022.html?d=dmtHMSContent


Robert H. Shmerling, M.D., Robert H. Shmerling, M.D., is associate
physician at Beth Israel Deaconess Medical Center and associate
professor at Harvard Medical School. He has been a practicing
rheumatologist for over 20 years at Beth Israel Deaconess Medical
Center. He is an active teacher in the Internal Medicine Residency
Program, serving as the Robinson Firm Chief. He is also a teacher in
the Rheumatology Fellowship Program.

pureheart

Medical Test Results: Are You Normal, And Is That A Good Thing?

Jan. 27, 2004

By Robert H. Shmerling, M.D.
Beth Israel Deaconess Medical Center

* "Everything Is Fine"
* When Something's Amiss
* When "Normal" Is Not Good
* Knowing The Limitations Of Testing
* The Bottom Line

When doctors talk shop, they often use terms to describe an examination
or test result by comparing it to "normal." While this might seem
straightforward, health-care providers use a number of expressions that
might confuse you if you aren't prepared. Read on to learn how to
interpret what your doctor is saying when he or she sends you a note,
calls you or talks with you in the office about the results of your
evaluation.

"Everything Is Fine"

Fortunately, in the majority of doctors' practices, the most frequent
result of an examination or testing is "normal." I recall having a
throat culture performed at the college infirmary; when I stopped by to
get the results, the physician simply pointed to the actual report from
the laboratory: It read "Negative" in bold letters. That worried me,
because I thought that "negative" meant something bad and that a
positive result was a good thing. In fact, when reading medical
results, it's usually the opposite; with rare exception, "negative"
is normal (because it means that an abnormal result is not present) and
"positive" is abnormal or unusual (because it means that something out
of the ordinary is present).

There are a number of ways health-care providers express normalcy.
These include:

* Within normal limits ("wnl") - Many test results have cutoffs
above which the result is too high and below which the result is too
low. Usually, these cutoffs are established by measuring the test in
normal, healthy people (called "a reference group") and figuring out
where 95 percent of the results fall; if your result falls in between
the cutoffs, your health-care provider may call it "wnl," "in the
normal range" or "within the reference range."


* Unremarkable - An unremarkable result means that it is much
like other, normal results. Generally, that's a good situation.
It's usually good not to be too "interesting" when it comes to your
health, so hearing that your result is unremarkable should not be taken
to mean that your doctor is not interested or impressed with you!


* Unimpressive - As above, this term implies that if there is any
abnormality detected, it is minimal or insignificant.


* Nonfocal, or, no focal abnormalities - These terms rely on the
finding that in the human body, there is often symmetry between the
right and left sides and there is uniformity in the makeup of many
organs. If there is a "focal" finding, it indicates a localized
abnormality where none should exist; examples include a difference in
the knee reflexes, or a spot on a chest X-ray where usually the lung
appears uniform. "Nonfocal" findings usually indicate the absence of
such an abnormality.


* Intact - This is used to indicate that something that should be
present is in fact present. Examples include pulses or reflexes.


* Non-pathologic, benign - Some serious abnormalities have
features that distinguish them from unimportant ones. For example,
lymph nodes may enlarge to a certain point in healthy people, but above
a certain size could indicate cancer or other problems. If a CT scan
reveals slightly enlarged lymph nodes that otherwise appear normal, the
report may describe them as "benign-appearing" or "non-pathologic,"
indicating the likelihood that they are not an indicator of cancer or
other serious illness.


* Insignificant - This term is often used in the usual way, to
describe a finding that may be minimally abnormal or abnormal in an
unimportant way (for example, as a freckle on the skin). Another way
this term is used is as a statistical measure regarding the likelihood
that an abnormal finding is "truly abnormal" or "abnormal due to
chance." When the findings are mathematically estimated to occur just
as a matter of chance, the results may be termed "insignificant."


* Stable - This indicates that the result is similar to previous
findings; while it may not technically be normal, if it is not changing
over time, at least the abnormality is not worsening. Such a finding
generally provides some measure of reassurance.

Back to top

When Something's Amiss

Frequently, when the results of an examination or a test are not
normal, the abnormality is minor and has little or no bearing on your
health. So, health-care providers have a number of ways to express a
result that is not normal, but often provide descriptive detail to
specify just how abnormal or concerning it is.

For some tests, such as blood counts, the result is high, low or
normal. For others, such as an X-ray, results may show an abnormality
of little importance, such as a speck of calcium in the lungs or
scarring from past pneumonia. It is not rare that the importance of an
abnormality is not known right away and that more testing or the
passage of time is needed to know for sure how meaningful it is.
Examples of ways an abnormal examination or test results might be
expressed by a health-care provider include:

* Elevated/increased/high - For example, the white-blood-cell
count may be elevated in people with infection.

* Depressed/decreased/low - For example, anemia is defined by
having a reduced number of red blood cells. Blood pressure and hormone
levels are other common examples of results that are typically
expressed as high, low or normal.

* Minimal, mild, moderate, marked, severe - Any abnormality may
be described in terms of how abnormal it is. For example, X-rays may
indicate mild joint disease even in persons without symptoms; such
findings are common in people over the age of 50 even if the joints
feel fine. However, severe joint disease on an X-ray is less commonly
seen in people whose joints feel fine, so the severity of the
abnormality on an X-ray is typically described by radiologists in these
terms.

* Uncertain significance - Because tests have not been evaluated
in every conceivable situation, their results may be abnormal but the
importance of the finding is not completely understood. A good example
of this type of finding is the magnetic resonance imaging (MRI) test.
When it first became available, spots were observed in the brains of
many normal people (in fact, they were often referred to as
"unidentified bright objects" or UBOs, because they appeared lighter
than normal brain tissue). Such findings are common for many tests,
particularly those that display images of the body.

When "Normal" Is Not Good

There are times when a result that is out of the normal range is a good
thing and what is usually considered "normal" is bad. For example, if
you are taking the blood thinner warfarin (Coumadin), the test that
measures blood clotting, (called the International Normalized Ratio, or
INR) should be elevated; it indicates that clotting of the blood is
less likely, a good thing for people who have had problems with blood
clots. Getting the blood "thinner" and less likely to clot is the
reason people take warfarin. While the urgency depends on the reason
you are taking warfarin, a normal result is not a good result; it
indicates that the medication is not thinning the blood enough. Another
example is a pregnancy test; if you are trying to become pregnant, a
"positive" result (indicating that you are pregnant) is a good thing
and a negative result may be cause for disappointment.

Knowing The Limitations Of Testing

A key part of understanding one's test results is knowing what the
test is supposed to do. When I learned that my throat culture was
"negative," that only meant I was less likely to have strep throat.
There was still a small chance I had strep infection (because the test
isn't perfect), and I could still have a number of other causes of a
sore throat, such as a viral infection or even a bacterial infection
other than strep. The test did not mean I was healthy; it could only
help to make one diagnosis (strep throat) more or less likely. Asking
your doctor about the purpose of your tests may help you to understand
their results.

The Bottom Line

The real significance of any particular test result depends on a number
of factors, including why it was ordered, what is normal or usual for
you, whether the test result is getting better or worse, whether you
are getting better or worse, how abnormal it is, and whether it may
even represent an error in the test (rather than disease in you).

But, don't be disappointed if your examination is "unimpressive" or
your test results are "unremarkable." When you are under medical
evaluation, those findings are often the best you can have. On the
other hand, if your results are abnormal, do not panic; your doctor
cannot be positive that your positive results indicate a negative
health outcome. Sometimes the most difficult part about getting your
results is figuring out what your doctor is saying.

Robert H. Shmerling, M.D., Robert H. Shmerling, M.D., is associate
physician at Beth Israel Deaconess Medical Center and associate
professor at Harvard Medical School. He has been a practicing
rheumatologist for over 20 years at Beth Israel Deaconess Medical
Center. He is an active teacher in the Internal Medicine Residency
Program, serving as the Robinson Firm Chief. He is also a teacher in
the Rheumatology Fellowship Program.