If you’re like most people, you assume that you need the tests and treatments that your doctor orders.
But that’s not always true. According to a report from the National Physicians Alliance, some of the most frequently used tests and treatments often are unnecessary—and may be harmful. Even the common PSA test to detect prostate cancer has come under scrutiny recently.
The excessive use of tests and treatments adds billions of dollars to the nation’s spiraling health-care costs. And these can lead to further—and also unnecessary—testing if there’s a false-positive, a reading that indicates an abnormality when everything actually is normal.
Why do doctors order questionable tests and treatments? One reason is habit. Doctors tend to do things the way they were taught in medical school even though new evidence shows that something isn’t helpful. Also, many doctors practice “defensive medicine” to reduce the risk for lawsuits, assuming that a physician is unlikely to get sued for giving too much care.
If your doctor recommends any of the following tests and treatments, ask him/her whether they are really necessary and why…
1. Imaging for low-back pain. Pain in the lower back is the fifth-most-common reason for doctor visits. Doctors routinely order MRIs of the lumbar spine when patients complain about back pain.
The problem: In the vast majority of cases, imaging tests are unnecessary. Low-back pain typically clears up without treatment in six weeks or less.
Exceptions: MRIs or other imaging tests may be needed for severe low-back pain or pain that lasts longer than six weeks…or when the symptoms include fever, incontinence, numbness and tingling.
2. Blood tests/urinalysis. When you have an annual exam, your doctor might order urine and/or blood tests. A urine test typically is used to check for diabetes. Blood chemistry panels are used to screen for diseases of the kidneys, liver and parathyroid gland, among many other things.
The problem: These tests rarely reveal anything in patients without symptoms who generally are healthy—and they often lead to false-positives.
Exceptions: Patients with specific symptoms—such as a persistent fever or tenderness in the abdomen—probably will need to have blood tests to determine the cause. A blood test also is recommended for checking cholesterol levels.
Urinalysis can be used to identify diabetes in patients who already have symptoms, such as frequent urination and/or increased thirst.
There may be other good reasons your doctor wants to order blood and/or urine tests, but he should be willing to explain to you exactly what those reasons are.
3. Cardiovascular screening. You don’t need an annual electrocardiogram (EKG) if you don’t have symptoms of, or risk factors for, heart disease (such as smoking, diabetes or a family history of cardiovascular disease).
The problem: Many doctors advise patients to have an EKG every year. My doctor used to recommend it for me, but in patients without symptoms, an EKG rarely reveals useful information. It may show a minor abnormality in the heartbeat that will lead to further tests, such as an echocardiogram or a stress test, even though these abnormalities rarely are important.
Exceptions: Patients who have been diagnosed with heart disease or who have significant risk factors for it probably will need an annual EKG or other cardiac tests.
4. Bone-density scan. More than 28 million Americans have osteoporosis, the leading cause of weak bones and fractures. A test called dual energy X-ray absorptiometry (DEXA) can detect bone weakness before a fracture occurs. This gives patients time to increase bone strength with exercise and vitamin D/calcium supplements.
The problem: The test doesn’t make sense for younger patients with a low risk for osteoporosis. If you’re a woman under age 65, you routinely should be taking calcium and vitamin D supplements and exercising to increase bone strength. The test itself won’t change the treatment recommendations even if you test positive.
Exceptions: Women who are younger than 65 who have osteoporosis risk factors, such as smoking, a slight build, hyperthyroidism or a history of bone fractures, should have this test. So should men younger than age 70 with the same risk factors.
Women age 65 and older and men age 70 and older should have the DEXA screening even if they don’t have risk factors. The DEXA test is important for these groups of people because they have a high risk for fractures and might benefit from medications.
5. Antibiotics for sinus infections. Patients don’t realize that any upper-respiratory infection, including a cold, will cause infection and inflammation throughout the area, including in the sinuses. They often ask their doctors for antibiotics to clear up postnasal drip, congestion or other sinus symptoms.
The problem: About 98% of sinus infections are caused by viruses. Antibiotics do nothing for viral infections. Even when a sinus infection is caused by bacteria, it usually will clear up without antibiotics.
Exception: Antibiotics should be considered for a sinus infection if the symptoms are severe, such as high fever and severe pain and tenderness over the sinuses. Antibiotics also should be considered when the symptoms last for one week, improve briefly and then get worse—this may indicate that a bacterial infection has developed on top of the initial viral infection.
6. Brand-name statins to lower cholesterol. The statin class of medications is among the best ways to lower cholesterol and reduce the risk for heart attack and stroke among people who can’t achieve these goals with diet and exercise. All statins have these benefits, including the generic versions.
The problem: Many doctors routinely prescribe expensive brand-name statins, such as Crestor or Lipitor, rather than the cheaper generics lovastatin, simvastatin or pravastatin. A generic statin costs about $4 a month. A brand-name medication such as Lipitor (atorvastatin), depending on the dose, costs about $150. However, Lipitor loses patent protection this month, which means a cheaper generic version will become available.
Between 75% and 80% of patients can achieve the recommended levels of LDL cholesterol (below 130 mg/dL is typical) by taking generic statins.
