[Risks in modern diagnosis]

The first principle in diagnosis, as in treatment, is: nil nocere. Modern methods of diagnosis are becoming more and more technical. They often create physical and mental stress to the patient, and have undesirable side-effects of varying kinds and degrees. To be aware of contra-indications is important not only for the doctor but also for the patient, who must be informed of the risk of a diagnostic procedure. The data presented gives statistical information from which the doctor can see the number likely to be at risk from his diagnostic methods. The most common methods and their adverse effects are mentioned: intravenous use of X-ray contrast media, invasive tests (peripheral, cerebral, coronary, renal angiographs), laparoscopies with and without liver biopsies, kidney biopsies, endoscopies (oesophago-gastro-duodenoscopy, colonoscopy, retrograde cholangio-pancreatography), percutaneous lung biopsy and mammography. Although the mortality rates of all methods of diagnosis, even the most hazardous ones, are relatively low, all techniques create a stress to which not every patient is accustomed; they all demand considerable co-operation for which not every patient is prepared. There is now a trend towards non-invasive diagnostic techniques, creating little or no stress, but which nevertheless give at least a comparable level of diagnostic efficiency (e.g. ultrasonics, isotopes and computer tomography).