You might think that gastroenterologists like me are conversant with food allergies. You would be wrong. Here is a second misunderstanding you likely harbor. Most individuals who believe or suspect that they are suffering from a food allergy have no allergic condition at all. A true allergic reaction involves the firing off of one’s immune system in response to an external stimulant resulting in a rash, wheezing and other characteristic allergic responses. Poison ivy, for example, is an allergic reaction. Nausea resulting from an antibiotic is not an allergic reaction. Physicians, of course, appreciate this distinction. This is why when you tell us you are ‘allergic’ to a medication, we will ask you specifically what the reaction was. In my experience, most of these ‘allergic reactions’ are routine non-allergic side effects. Often enough, a patient will claim to have a penicillin allergy, for example, but has no clue what the reaction might have been.
There are many forces driving utilization in health care. Patients come to doctors for explanations and relief. They relate symptoms that will likely lead to diagnostic testing. For example, if you tell your physician that you have a burning sensation when you urinate, it is likely that you will be asked to surrender an aliquot of your urine for analysis. If you enter your doctor’s office with some difficulty breathing, fever and a cough, I’ll wager that there’s a chest x-ray just around the corner. These diagnostic tests are appropriate. When does utilization morph into overutilization? I don’t know where the threshold between them lies. Moreover, doctors disagree amongst ourselves on what constitutes an unnecessary medical test. Doctors agree that there is too much testing and prescribing going on, but they tend to point their fingers toward their colleagues rather than toward themselves. Think of politicians here. It’s common for a congressman to criticize another cong