Every day, family physicians have patients with abnormal lab test results. Most of the time, the abnormal results can be explained easily because they are related to a diagnosis for which they’ve been treated for some time. For example, diabetics are going to have abnormal blood sugars, electrolytes, or cholesterol depending on the state of control of their diabetes. It’s a straightforward fact, and there is an obvious explanation for the abnormalities.
On the other hand is the asymptomatic patient who is having his annual physical and some of his lab results are abnormal. The most notorious of these abnormalities is mildly elevated liver enzymes. The ALT, AST, and Alkaline Phosphatase are the culprits is this situation, and in my experience, can lead to a great deal of frustration for the doctor and anxiety for the patient. Whenever the doctor is faced with a healthy, asymptomatic patient with no risk factors, with slightly abnormal lab results he has three choices: 1. Do nothing. 2. Repeat the tests to verify accuracy. 3. Do a full evaluation of the abnormalities including ancillary blood tests and imaging studies related to the abnormality.
Ignoring abnormal labs is always the wrong choice. The least one should do is repeat the tests. If the tests are still abnormal, and if the patient is still asymptomatic, it is ok to wait a month and repeat them again. If the results are better, wait another month or two and repeat them again. If the patient remains asymptomatic and the tests aren’t getting worse, repeat them every 3 months, unless they worsen or symptoms begin. If the test results are worse, a full work up is warranted. Ultrasound, CT, MRI, or other tests pertinent to the abnormality should be done looking for any reason to explain the abnormality.
As I mentioned before, this can be a frustration for the doctor and very worrisome for the patient. Each test done is met with the fear it will be abnormal and reveal something bad. In the majority of cases, however, the work up is negative and a bit of a wild goose chase. Occasionally, a problem is diagnosed, and it is treated accordingly.
Health care economists would argue that routine blood tests are not cost effective and should not be done for asymptomatic patients. They are right economically. As a cost-saving measure, Medicare doesn’t pay for routine screening blood tests so most patients refuse to have them. Some patients opt to have blood work done knowing they will have to pay for it. I encouraged patients to have an annual physical with blood work because my residency training had strongly emphasized preventive care, and a physical was the centerpiece of that process. Patients were told in advance which elements of the physical would and would not be covered, and they agreed to pay for them or refused the test. It was a system that worked well for 40 years.
A major offshoot of the annual physical was the occasional unexpected abnormal lab result. It caused anxiety in patients, but follow up evaluation usually resolved the dilemma with a favorable outcome. If I were still in practice, I’m sure I would still do physicals with blood work as I always did.
Reference: Personal experience and remembrances of William M. Gilkison MD
de La Serna A. Abnormal Lab Values: When Testing May Be Unnecessary. Medscape 2026 April 1.
