What to ask after getting a medical diagnosis
Plus: What’s “malignant”? + Former U.S. surgeon general health tip + Asking for a second opinion
Welcome to Doing Well. Today:
A Q&A on medical diagnosis and medical technology
Learn how wastewater can be used for diagnostics and monitoring public health
Word of the week: “malignant”
Let’s get started.
We Asked: How is technology changing the way we diagnose—and treat—disease?
Around 70% of health care decisions are made based on the results of diagnostic tests, according to the World Health Organization. These tests—which include everything from a blood test to a colonoscopy to an MRI to a pregnancy test—help health professionals detect, understand, treat, and monitor health conditions. Diagnostic tests are a little like car headlights—without them, we’re stuck driving in the dark.
Despite the key role diagnostics plays in health care access and decisions, many of us aren’t aware of what happens in the in-between space after we take a health test but before we act on its results. To understand that in-between space, and the broader diagnostics field, I spoke with Mara Aspinall, a professor at ASU’s College of Health Solutions and the cofounder of ASU’s biomedical diagnostics program. Mara is also a partner at Illumina Ventures and the coauthor of Sensitive & Specific: The Testing Newsletter, published on Substack.
We discussed how technology is shifting the ways we test and treat disease, and the questions you can ask after a medical diagnosis. Our conversation has been edited for length and clarity.
Mia Armstrong-López: What do we mean when we talk about diagnostics?
Mara Aspinall: Diagnostics—or as we call it at ASU, biomedical diagnostics—is medical testing to look at a person’s state of health. And with that state of health, we can make decisions about what to do next.
I think about it as five different categories: It's screening—mammography is a great example of early screening that goes out to millions of people who have no symptoms. Secondly, it's early diagnosis: Okay, somebody has symptoms. Are they likely to have a disease?
Next is the actual diagnosis. Then it's what's called prognosis: What type of disease or condition might the person have? All diseases are not the same. Cancer is a great example: There are different types of cancers—different kinds of breast, lung, or any other type of cancer—that have a good or not-so-good prognosis. Is it the type that is very difficult to treat or easier to treat? And lastly, what we call monitoring disease: How has the treatment worked or not worked?
When I talk about monitoring, we can talk about a test called an MRD test—minimal residual disease. I'll stick with the cancer analogy: For somebody undergoing chemotherapy and radiation for cancer, we presume today that everyone gets roughly the same therapy, six rounds of chemo and eight weeks of radiation therapy for each disease type. There's an average. That's great if you're average—but most people aren’t exactly average, we're more or less. And so this test looks for as little as one single cell that continues to be in the body. And when that test is negative, then there's a much more informed decision to stop therapy. If the MRD test shows there are still cancer cells, even if the average is six rounds of chemo, they'll say, “No, we want to do seven or eight.” This new approach can help more precisely personalize and test along the way to get the highest chance for remission—or even, in some cancers, cure.
MAL: It's an example of how technological advances can impact people's lives by personalizing medicine. What is personalized medicine?
MA: Personalized medicine, sometimes called precision medicine, is the core of treatment today. It is the combination of testing with the ability to be as precise as possible with the patient and diagnosis.
A good example is breast cancer: 50 years ago, breast cancer diagnosis was not personalized at all. It was the hallmark of a lump or a tumor in the breast. We now know there are different types of breast cancer, all different subcategories of disease. What is the subtype of breast cancer? And therefore, how should it be treated? In the old days, breast cancer was treated the same, with typically a radical mastectomy and maybe follow-up treatment. We now know that some tumors respond to hormones afterward, some don't; some people respond to chemotherapy, some chemotherapy is more dangerous than the breast cancer. So all the testing makes the diagnosis as accurate and as precise as possible.
MAL: There are so many different tests and technologies. How can someone understand the technology being used in their care?
MA: The core is to be asking questions. When you get a serious diagnosis, you can't expect to have all the questions ready at the moment. Serious doesn't always mean life-threatening, it just means something that changes how you go about your life.
The first piece is to go with the physician to ask: How confident are you in this diagnosis? Is it 100% clear it’s this, or is there any possibility it could be something else?
Number two, I would ask: What are the options for treatment? What is most common? What is least common? If a physician knows one aspect of treatment, because that's the treatment they've used before successfully, they might guide all their patients to that treatment.
The third question I would ask is: Is there anything unique about my diagnosis? Is there anything that interacts with the fact [for example] that you have diabetes or don't have diabetes; that you've had—or have never had—cancer in the past?
Lastly, I would ask: What are the core risks of no treatment, and what are the risks of the individual treatments that the doctor is recommending? When I say risks, it’s not always life-threatening risks; you can put side effects into that same bucket, so you know what to expect moving forward.
MAL: That ties into monitoring disease. Sometimes people will live with a disease for many years, or for their whole lives. What should people ask when it comes to a physician’s plan for monitoring health and disease?
MA: Unfortunately, in our current healthcare system, doctors don't always have the resources to stick with a patient to monitor long-term. A patient needs to understand who the physician is that they will see moving forward. If it's a course of treatment that's six months, ask: Who do I see after the six months?
Again, I'll use the [cancer] example: You'll be with one doctor for a very intense period. Then, if you go back to your general practitioner, will that person know how to monitor you going forward? I would ask: Who's going to take responsibility for me after the treatment? What are the signs that you would look for to say that the treatment is working? How frequently do I need to get an update on my condition?
The last thing I would think about discussing with your physician is: How will the physician monitor you? Is it a CT scan, an MRI, something that you have to interact with the medical establishment to do? Or is it self-reported, like energy levels? Is it something you can test for at home?
MAL: Technology has given us access to new sources of data on our health. How do you know what to pay attention to?
MA: I wish I knew an easy answer to this question, because it is highly personal. Let me acknowledge that [around] 25% of the country does not have a regular general practitioner to ask this question—but for people who do, ask: Given my age, given my condition, what is the most important thing that you need to see?
It's very easy not to ask and assume the health care professional will take care of you. And it’s not that they don't want to—but they have a lot of people [to take care of]. You've got to ask the physician what to look for.
MAL: For someone who is not looking at diagnostics professionally, but is interested in keeping up-to-date on the technology, what recommendations do you have?
MA: There's no better time to keep up with technology as there is today. There are a lot of great sources out there; I would suggest picking a few authors you trust and sticking with them. Ask your physician, What does he or she look for? What are the key sources of information?
The biggest challenge is not overreacting to one data point. There is so much information; you've got to find sources that you trust. If it's something very specific to you, go to the patient association—that is often one of the very best sources of data that's relevant to your disease, your condition, your age. Don't be afraid to make a call—I've been really impressed over the years that you can call these patient associations and ask them to help point you in the right direction.
Well-Informed: Related stories from the ASU Media Enterprise archives
One in two women has dense breast tissue, which can make breast cancer both more likely and harder to identify. Bhavika Patel, the chair of radiology research at Mayo Clinic Arizona, joined Arizona Horizon to discuss what dense breast tissue is, how to know if you have it, and how specialized screening techniques can improve disease detection.
Plus: Imagine a future with a disease-detecting robot trained to scout for outbreaks in hard-to-reach communities. In the short story “When Robot and Crow Saved East St. Louis,” Annalee Newitz explores creative ways of identifying and treating illness. The story is part of the Future Tense Fiction series, published in Issues in Science and Technology.
Well-Versed: Learning resources to go deeper
Wastewater can hold important clues for our health—but we have to know how to listen to what it’s telling us. To learn more about the connection between wastewater, diagnostics, and public health, check out this self-paced online class taught by Rolf Halden, director of ASU’s Center for Environmental Health Engineering at the Biodesign Institute.
Well-Attended: Related community events
Interested in learning more about health and technology? On Friday, May 16, ASU’s College of Health Solutions is hosting the Arizona Digital Health Symposium, which will explore how digital innovations can improve health outcomes. Then, on Saturday, May 17, the Arizona Alzheimer’s Consortium is hosting a forum for patients, caregivers, and family members to share the latest advances in the diagnosis and treatment of Alzheimer’s disease. Both events will be held at the ASU Health Futures Center.
Well-Read: News we’ve found useful this week
“F.D.A. Approves First At-Home Alternative to the Pap Smear,” by Maggie Astor, May 9, 2025, The New York Times
“Teachers and Librarians Are Among Those Least Likely to Die by Suicide—Public Health Researchers Offer Insights on What This Means for Other Professions,” Jordan Batchelor, Charles Max Katz, and Taylor Cox, May 5, 2025, The Conversation
“How Much Should Doctors Dwell On Risks?” by Melissa Dahl, May 2, 2025, Slate
“Utah’s Ban on Fluoride in Public Water Is a Simple Change That Raises Complicated New Health Risks, Experts Say,” by Deidre McPhillips, May 7, 2025, CNN
Well-Engaged: Getting a second opinion
How many patients who request a second opinion get a completely different diagnosis?
You’ll find the answer at the bottom of today’s newsletter. In the meantime, here’s what to know about second opinions:
Getting a second opinion on a medical diagnosis or procedure can be stressful and costly. But sometimes it’s necessary. If your symptoms don’t align with the diagnosis you were given, if you’re diagnosed with a rare condition, or if you feel uncomfortable with your doctor, diagnosis, or prescribed treatment, having another provider’s perspective can help you be more confident in the path forward.
So how exactly can you ask for a second opinion? You can first choose to share your concerns with your provider about the diagnosis or treatment suggested. This can be helpful because the original provider may be able to provide more information based on your feedback. If you still have concerns after that conversation, ask your current provider for a referral. You can say: “Before moving forward, I’d like to get a second opinion so I can make sure I have all the information I need to make an informed decision. Could you help me with a referral, and ensure my medical records are sent over?” If you have health insurance, check your insurance plan’s website or call their support number to make sure your plan will cover the care.
When communicating with your original provider, remember that they want what’s best for you. Second opinions are common practice, so they shouldn’t be offended if you want more information. In conversations with your new provider, ensure they’ve reviewed your medical records, including test results and prescriptions. Tell them the diagnosis you received or treatment that’s been suggested, and ask them if they agree the diagnosis is correct and that the proposed treatment is the best course of action. It’s important that you are confident in your health care and medical team!
-Mel Moore, health communication assistant
Well-Defined: Word of the week
The word “malignant” is typically used to describe cancerous cells that grow in an uncontrolled way and can spread to other parts of the body. The word malignant comes from the Latin word malignans, which means “malicious.” A way to remember this term when bombarded with scientific language is with the prefix mal-, meaning “bad”. If tissue is not malignant, it is “benign.”
-Mel Moore, health communication assistant
Well-Advised: One thing that’s improving our health
Richard H. Carmona, former U.S. surgeon general and a laureate professor of public health at the University of Arizona, shares his experience prioritizing his own health while juggling the stresses of one of the country’s top health roles:
As U.S. Surgeon General, with many distractions before me on a daily basis, it was essential that I “walk my talk” to optimize my health by prioritizing regular physical activity, eating a balanced nutritional diet, getting enough sleep and managing stress. In doing so, we can all live longer, younger, happier, healthier and cheaper!
Question: How many patients who request a second opinion get a completely different diagnosis?
Answer: Answer: 21% according to a study of patients who sought second opinions at the Mayo Clinic.
Do you have a question or topic you’d like us to tackle? Would you like to share your experience? Reach out at any time—we’d love to hear from you.