Too many tests? Routine checks getting second look
January 23, 2012 By LAURAN NEERGAARD , AP Medical Writer in Cancer
Recent headlines offered a fresh example of how the health care system subjects people to too many medical tests - this time research showing millions of older women don't need their bones checked for osteoporosis nearly so often.
Chances are you've heard that many expert groups say cancer screening is overused, too, from mammograms given too early or too often to prostate cancer tests that may not save lives. It's not just cancer. Now some of the nuts-and-bolts tests given during checkups or hospital visits are getting a second look, too - things like routine EKGs to check heart health, or chest X-rays before elective surgery. Next under the microscope may be women's dreaded yearly pelvic exams.
The worry: If given too often, these tests can waste time and money, and sometimes even do harm if false alarms spur unneeded follow-up care.
It begs the question: Just what should be part of my doctor's visit?
If you're 65 or older, Medicare offers a list of screenings to print out and discuss during the new annual wellness visit, a benefit that began last year. As of November, more than 1.9 million seniors had taken advantage of the free checkup.
For younger adults, figuring out what's necessary and what's overkill is tougher. Whatever your age, some major campaigns are under way to help. They're compiling lists of tests that your doctor might be ordering more out of habit, or fear of lawsuits, than based on scientific evidence that they are really needed.
"Too often, we order tests without stopping to think about how (if at all) the result will help the patient," wrote Dr. Christine Laine. She's editor of Annals of Internal Medicine, which this month published a list of 37 scenarios where testing is overused.
Not even physicians are immune when it comes to their own health care. Dr. Steven Weinberger of the American College of Physicians had minor elective surgery for torn knee cartilage about a year ago. The hospital required a pre-operative chest X-ray, an EKG to check his heart, and a full blood work-up - tests he says aren't recommended for an otherwise healthy person at low risk of complications.
Weinberger should know: He led the team that compiled that new list of overused tests. All three examples are on it.
"If anyone should have objected, I should have objected, but I took the easy way out. I didn't want to be raising a fuss, quite frankly," he says.
The college of physicians' push for what it calls "high-value, cost-conscious care" - and similar work being published in the Archives of Internal Medicine - aims to get more doctors to think twice so their patients won't be put in that uncomfortable position. Another group, the National Physicians Alliance, is studying whether training primary care doctors in parts of Connecticut, California and Washington about the most overused care will change their habits.
Medical groups have long urged patients not to be shy and to ask why they need a particular test, what its pros and cons are, and what would happen if they skip it. This spring, a campaign called Choosing Wisely promises to provide more specific advice. The group will publish a list of the top 5 overused tests and treatments from different specialties. Consumer Reports will publish a layman's translation, to help people with these awkward discussions.
For now, some recent publications offer this guidance:
-No annual EKGs or other cardiac screening for low-risk patients with no heart disease symptoms. That's been a recommendation of the U.S. Preventive Services Task Force for years. Yet a Consumer Reports survey of more than 8,000 people ages 40 to 60 found 44 percent of low-risk, people with no symptoms had undergone an EKG or similar screening. Simple blood pressure and cholesterol checks are considered far more valuable.
-Discuss how often you need a bone-density scan for osteoporosis. An initial test is recommended at 65, and Medicare pays for a repeat every two years. A study published last week found that a low-risk woman whose initial scan is healthy can wait up to 15 years for a repeat; those at moderate risk might need retesting in five years, high-risk women more often.
-Women under 65 need that first bone scan only if they have risk factors such as smoking or prior broken bones, say the two new overtesting lists.
-Most people with low back pain for less than six weeks shouldn't get X-rays or other scans, Weinberger's group stresses.
-Even those all-important cholesterol tests seldom are needed every year, unless yours is high, according to the college of physicians. Otherwise, guidelines generally advise every five years.
-Pap smears for a routine cervical cancer check are only needed once every three years by most women. So why must they return to the doctor every year to get a pelvic exam (minus the Pap)? For no good reason, the Centers for Disease Control and Prevention reported last month. Pelvic exams aren't a good screening tool for ovarian cancer, and shouldn't be required to get birth control pills, the report says.
Yes, simple tests can harm. Cleveland Clinic cardiology chief Dr. Steven Nissen cites a 52-year-old woman who wound up with a heart transplant after another doctor ordered an unneeded cardiac scan that triggered a false alarm and further testing that in turn punctured her aorta.
A close relationship with a primary care doctor who knows you well enough to personalize care maximizes your chances of getting only the tests you really need - without wondering if it's all just about saving money, says Dr. Glen Stream of the American Academy of Family Physicians.
"The issue is truly about what is best for patients," he says.
More information: Medicare preventive services list: http://1.usa.gov/aiOTnS
©2012 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.
-
Annual cancer screening tests urged less and less
Oct 19, 2011 |
not rated yet |
0
-
Study: Docs overtesting for cervical cancer virus
Jun 20, 2011 |
not rated yet |
0
-
HPV test beats Pap for cervical cancer screening
May 18, 2011 |
not rated yet |
0
-
Many clinicians may be screening for cervical cancer too frequently
Jun 14, 2010 |
not rated yet |
0
-
'Top 5' list helps primary care doctors make wiser clinical decisions
May 23, 2011 |
not rated yet |
0
-
Motion perception revisited: High Phi effect challenges established motion perception assumptions
Apr 23, 2013 |
3 / 5 (2) |
2
-
Anything you can do I can do better: Neuromolecular foundations of the superiority illusion (Update)
Apr 02, 2013 |
4.5 / 5 (11) |
5
-
The visual system as economist: Neural resource allocation in visual adaptation
Mar 30, 2013 |
5 / 5 (2) |
9
-
Separate lives: Neuronal and organismal lifespans decoupled
Mar 27, 2013 |
4.9 / 5 (8) |
0
-
Sizing things up: The evolutionary neurobiology of scale invariance
Feb 28, 2013 |
4.8 / 5 (10) |
14
-
Pressure-volume curve: Elastic Recoil Pressure don't make sense
23 hours ago
-
If you became brain-dead, would you want them to pull the plug?
May 17, 2013
-
MRI bill question
May 15, 2013
-
Ratio of Hydrogen of Oxygen in Dessicated Animal Protein
May 13, 2013
-
Alcohol and acetaminophen
May 13, 2013
-
Marie Curie's leukemia
May 13, 2013
- More from Physics Forums - Medical Sciences
More news stories
New smartphone application improves colonoscopy preparation
The use of a smartphone application significantly improves patients' preparation for a colonoscopy, according to new research presented today at Digestive Disease Week (DDW). The preparation process, which begins days in ...
Cancer
1 hour ago |
not rated yet |
0
Research examines new methods for managing digestive health
Research presented at Digestive Disease Week (DDW) explores new methods for managing digestive health through diet and lifestyle.
Cancer
1 hour ago |
not rated yet |
0
New colonoscope provides ground-breaking view of colon
A ground-breaking advance in colonoscopy technology signals the future of colorectal care, according to research presented today at Digestive Disease Week(DDW). Additional research focuses on optimizing the minimal withdrawal ...
Cancer
16 hours ago |
5 / 5 (2) |
0
ASCO: combo antibody therapy effective for melanoma
(HealthDay)—Concurrent use of two immune checkpoint antibodies—ipilimumab and nivolumab—may be effective for the treatment of advanced melanoma, according to a proof-of-principal study presented in ...
Cancer
May 17, 2013 |
not rated yet |
0
Risk factors ID'd for poor cutaneous cell CA outcomes
(HealthDay)—The risks of metastasis and death associated with cutaneous squamous cell carcinoma (CSCC) are low, but significant, and risk factors for poor outcome include tumor diameter, invasion beyond ...
Cancer
May 17, 2013 |
not rated yet |
0
|
Ketamine shows significant therapeutic benefit in people with treatment-resistant depression
Patients with treatment-resistant major depression saw dramatic improvement in their illness after treatment with ketamine, an anesthetic, according to the largest ketamine clinical trial to-date led by researchers from the ...
Consuming coffee linked to lower risk of detrimental liver disease, study finds
Regular consumption of coffee is associated with a reduced risk of primary sclerosing cholangitis (PSC), an autoimmune liver disease, Mayo Clinic research shows. The findings were being presented at the Digestive Disease ...
New research identifies practice changes to improve value and quality of GI procedures
There are significant cost and risk factors associated with two procedures commonly used to diagnose or treat gastrointestinal problems, according to research presented at Digestive Disease Week (DDW).
New research identifies risks, interventions for children's GI health
An increasing number of U.S. children are experiencing gastrointestinal issues that require interventions to resolve, according to research presented at Digestive Disease Week (DDW).
US psychiatry gets makeover in new manual
The latest makeover to a massive psychiatric tome honored by some, reviled by others and even called the "Bible" of mental disorders is being released Saturday with a host of new changes.
New case of SARS-like virus in Saudi: ministry
A new case of the deadly coronavirus has been detected in Saudi Arabia where 15 people have already died after contracting it, the health ministry announced on Saturday on its Internet website.