Are Medical Tests Always Necessary?

The cost of health care is of upmost concern for most Americans. Whether you have traditional health care, Medicare, or no health care, costs have skyrocketed over the last decade. Reimbusement for doctors on procedures performed is often very low. This affects the amount of money physicians are making. In order for doctors to make more money, they need to order more tests and/or procedures for their patients. Are all these tests really necessary? There is a great deal of controversy on this topic. I recently watched a documentary narrated by Sanjay Gupta, in which this very topic was addressed. One thing Dr. Gupta pointed out was that other countries like Germany and England, that are similar to us, do not perform as many tests, yet their people live longer. Also, we are the 50th country in the world in terms of longevity, and we are last in longevity amongst the western world. So, are all these tests making us healthier? They certainly aren't making us live longer. The good news is that if you make it to age 75 in America, your odds of living a really long life increase. So, why are American doctors ordering so many tests? One answer is that many patients want them, so patients must be educated and understand the risks and rewards of these tests. Next, doctors make money on these tests and procedures. Finally, they may be medically necessary. I recently went to an orthopedic surgeon for my knee, whom I hadn't been to in about 15 months. Before I even saw the doctor and explained why I was there, the nurse assistant said, "Let's get some new x-rays of that knee." I said, "No, I want to talk to the doctor first." I talked to the doctor, and no x-rays were taken. Below are some of the tests that medical groups are now questioning. Not that they're not necessary in many cases, but that they're not necessary in ALL cases. We must be our own advocat. We have to ask the right questions and to question doctors. After all, it's called medical practice for a reason. They don't have all the answers, philosophies are constantly changing, and you better ask the right questions or you will be subject to unnecessary tests and procedures. Questionable Tests, Procedures So what tests and procedures should you question, and when? Here are some examples of items on the list of 45 things doctors and patients should ask about: Exercise stress tests during routine physicals if you are at low risk for heart disease Imaging tests for non-specific low back pain that can't be attributed to a disease or condition after a doctor takes your history and examines you Antibiotics to treat an uncomplicated sinus infection; sinus infections are mostly caused by viruses, which do not respond to antibiotics. Imaging tests such as a CT scan or MRI if you faint and have no other neurological symptoms Chest X-ray, cardiac stress test, or imaging before non-heart surgery Dual X-ray absorptiometry (DEXA) for osteoporosis screening if you are a woman under 65 or a man under 70 with no risk factors for osteoporosis This is not to say that these tests or treatments are never needed, says ABIM Foundation president and CEO Christine Cassel, MD. "They are sometimes necessary and often overused," she says. "No treatment and no test, no matter how routine, is without some risk." For example, many of the groups focused on imaging tests such as DEXA, CT scan, and MRI. All of these tests expose a person to potentially harmful radiation. "When a doctor does a physical exam and takes a thorough history, they can say, 'Maybe you should have this,' but they should not be using these as routine things for everybody." Just a thought, but maybe doctors should get back to examining patients, rather than spending all their time at the computer writing down what the patient says. We've gotten away from the old fashioned physical. We've got so much new technology to help with diagnosis, but sometimes a physical exam is valuable. I will blog in the future about more specific tests that specialists now think may not always be necessary. Several doctors groups have gotten together, and specialty by specialty, have talked about what tests are and are not important. You're in charge of your health care, so know this information so you can talk intelligently to your doctor.