We all want to avoid serious illness, so it seems sensible to undergo a harmless test towards that goal. But when an entire nation takes more and more tests that save few lives, something has gone wrong. Unnecessary screening pushes up costs, and you as a patient waste your time and energy, as well as any cash you spend. Even worse, your test may lead to unnecessary procedures that interfere with your life for more than an afternoon.
This isn’t a minor problem. The Institute of Medicine has reported that 30 percent of the spending in the U.S. healthcare system is unnecessary. That’s about $750 billion a year — more than the nation's entire budget for K-12 education. The $750 billion includes administrative costs and fraud — but the single biggest factor is unnecessary care, including testing. Don’t assume that high costs are the price we pay for good health. Unnecessary care can do you harm and substitute for care you actually need.
Why do Americans take so many unnecessary tests? Patients may insist on some tests because they’ve heard that other people have had them, especially if they don’t know or trust their own doctors. It’s undeniably true that unnecessary tests and procedures are lucrative, although your own doctor may recommend them with a clear conscience, influenced by the profession as a whole. The medical guidelines may have changed or be unclear. Doctors may also be afraid of lawsuits — one report estimated that malpractice insurance and “defensive medicine” cost more than $55 billion a year.
Here’s our short list of tests you might skip unless your doctors believe they’re important for you in particular. (You should, however, know about recommended prevention guidelines.)
Heart disease scans. Given the rising numbers of people with heart disease, it’s tempting to include heart screens in a routine physical. But unless you are considered to be “intermediate risk” and are debating whether to take or continue a statin drug, you may not need a calcium scan checking for “plaques,” deposits of calcium that cause the lining of the coronary arteries to stiffen or swell. These scans increase your exposure to radiation, which it’s best to minimize. A computed tomography (“CT”) angiogram, designed to detect blockages in the chest or major blood vessels, may also be unnecessary, while posing radiation risk.
Prostate cancer screening. In a much-noted 2009 study, nearly 77,000 men at 10 U.S. medical centers were divided between a group that were offered a test or examination for prostate cancer annually over 8 years and a control group. The researchers concluded that the rate of death from prostate cancer was low and testing didn’t help.
Lung cancer screening. Some 10 to 15 percent of lung cancer patients never smoked. You can protect yourself by testing your home for radon and avoiding secondhand smoke or exhaust on the job or elsewhere. If you develop symptoms such as a lingering cough or chest pain, see a doctor who may order a CT scan. However, the American Cancer Society recommends routine lung cancer screening only for people ages 55 to 74 who smoked heavily within the previous 15 years. In one large study, about a quarter of the people screened had to undergo additional tests to discover that their abnormalities weren’t cancer.
Colonoscopy after 75. The U.S. Preventive Services Task Force (USPSTF) recommends tests for colon cancer from age 50 to 75 for most people and only for those with risk factors through age 85. The Task Force found that the evidence for CT colonography and fecal DNA testing screens is inconclusive.
Cervical cancer screens after 65. The USPSTF recommends against screening for cervical cancer in women older than 65 as long as they were screened previously and don’t have a special reason such as HIV infection or a history of precancerous lesions.
Skin tests for tuberculosis (TB). This test is useful for someone who has spent time with a TB patient, illegal drug users, people with weakened immunity, or those who have traveled in countries like Russia where TB is common. Unless you fall into one of those categories or have symptoms such as a fever and weight loss, don’t waste the effort.
MRIs for every little thing. Injured athletes and exercisers are often referred for an MRI, or magnetic resonance imaging, when they complain of pain. Dr. James Andrews, a Florida sports medicine orthopedist and researcher, suspected that the test led to unneeded surgeries. He scanned the shoulders of 31 professional baseball pitchers who had no complaints. Based on the scan results, nearly all of them had abnormal shoulder cartilage and rotator cuff tendons, he told the New York Times.
MRIs are an especially good example of how unnecessary tests have become so common. Patients may ask for an MRI or expect one, and doctors reap big fees for each scan. When they own their own machines, which is common, they might get $1,100 from an insurer for an MRI of the knee to identify a torn ligament, for example.
May 12, 2015
Janet O’Dell, RN