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Is American Medicine Too Test Happy?

December 30, 2011

THURSDAY, Dec. 29 (HealthDay News) — If you’ve had a medical
procedure lately, you probably first had blood tests, an imaging test like
an MRI or ultrasound, perhaps an electrocardiogram and possibly more.

“Is all this really necessary?” you might have wondered.

That’s a question that doctors themselves are now raising as a growing
body of evidence suggests that overuse of diagnostic testing may be
harming patients’ health and driving up health-care costs.

“There is clear overuse or misuse of certain kinds of tests for certain
patients,” said Dr. Steven E. Weinberger, executive vice president and
chief executive officer of the American College of Physicians.

So should doctors exercise more restraint, or should patients take a
more active and skeptical role in their care?

Weinberger believes the answer lies somewhere in the middle. “There
needs to be an honest conversation in both directions, with a clear
understanding about what is and isn’t necessary,” he said.

Experts agree that excessive testing is costing the U.S. health-care
system billions through waste. Weinberger said that some estimates have
suggested the cost could run as high as $200 billion to $250 billion a
year, an amount equal to about 10 percent of the total amount spent on the
nation’s health care.

But the true cost is borne by patients who face increased health risks
associated with diagnostic testing, he said. Dr. Anthony Shih, executive
vice president for programs of the Commonwealth Fund, a private health
policy research foundation, agreed.

“Although most patients are aware that procedures carry some risks,
they are less aware that tests carry risks,” Shih said.

Diagnostic testing, in fact, carries three main risks, Weinberger and
Shih said:

  • Risks directly related to the test itself, such as the radiation
    exposure caused by imaging tests.
  • The risk for a false positive, which can lead to a string of other
    unnecessary follow-up tests and procedures, each with their own sets of
    potential health hazards.
  • The risk that a condition will be identified that never would have
    been clinically significant but now will probably be treated.

A routine electrocardiogram, for example, might identify some
nonspecific condition that leads to a cardiac catheterization, an invasive
medical procedure that carries its own set of health risks, Weinberger

“Unnecessary testing is not necessarily benign,” he said. “It can lead
to situations that can pose health risks to patients.”

Clearly, patients should become more active in asking whether tests are
necessary. But as most anyone who’s been a patient can attest, asking such
questions can be daunting for anyone, but especially for a sick person who
needs treatment.

Weinberger said he has personal experience when it comes to the
difficulty of challenging tests as a patient. He recently had arthroscopic
surgery for a knee injury, but before the procedure he had to undergo a
battery of diagnostics that included lab tests, a chest X-ray and an
electrocardiogram — all unnecessary, as far as he could tell. And yet, he
had the tests without questioning them.

“My experience shows you how hard it is,” Weinberger said. “If there’s
anyone who was in a position to question these tests, it’s someone like
me.” But, he admitted, “you don’t want to antagonize the person who’s
going to provide your care. Sometimes the easiest road is to just go

His organization, the American College of Physicians, has started
tackling the issue through what it calls its High-Value, Cost-Conscious
Care Initiative, which aims to reduce unnecessary testing by educating
physicians and patients alike on the benefits, harms and costs of tests
linked to specific ailments.

“We’re basically trying to develop a list of those types of things that
are overused and explore the evidence behind why they are overused,”
Weinberger said.

Shih said that people who are facing diagnostic tests should use such
resources to educate themselves and then feel free to question their
doctor about the tests that have been ordered.

“The patient should always ask what the test is looking for, what the
potential harms are for the test, and what the next steps are if the test
finds something,” he said. “As the tests get more invasive and more
complex, I would be more careful about asking for the reasoning behind
each test.”

Ultimately, however, both patients and doctors need to keep in mind
that the necessity of tests is a very specific and personal matter, Shih

“It’s important to recognize that for any given patient, even with the
exact same condition, the decision may not be the same,” he said. “It
depends on the values and preferences of each patient.”

“Some patients want to be absolutely sure, while other patients may be
more comfortable with uncertainty,” Shih explained. “There is no
hard-and-fast rule for which tests might be appropriate for each

More information

The U.S. Agency for Healthcare Research and Quality has more on communicating with your

Article source: http://news.yahoo.com/american-medicine-too-test-happy-140304848.html


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