WASHINGTON — 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, from mammograms given too early or too often to prostate cancer tests that might 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, things like routine EKGs to check heart health or chest X-rays before elective surgery.
Next under the microscope might 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: What should be part of doctor visits?
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, 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, 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 said 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 said.
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.
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 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, said Dr. Glen Stream of the American Academy of Family Physicians.
“The issue is truly about what is best for patients,” he said.