Are you getting cookie-cutter medical care? Too many people are—and one glaring example of this is the number of tests and procedures that are being prescribed regardless of the individual’s specific health situation.

In fact, there’s more and more evidence that many of the tests that are given so routinely are causing more harm than good.

Here are some popular tests that are often not necessary…*

CT SCANS FOR LOW-BACK PAIN

If your low back is giving you fits, your doctor may order an X-ray or even a more detailed test such as a CT scan to see what’s going on.

Problem: Americans are receiving doses of radiation from X-rays and CT scans (not to mention spending enormous amounts of money) to diagnose a problem that will likely go away on its own in a few weeks. In some cases, an incidental finding that’s not even related to the pain leads to unnecessary back surgery.

New thinking:

  • Unless you are experiencing worsening nerve damage (such as loss of bladder or bowel control or loss of sensation or muscle power in your legs) or have cancer (which could possibly spread to the back), you probably don’t need an imaging test within the first six weeks of your back pain.

Also: There is no medical or legal reason to get X-rays as a “baseline” for work-related back injuries.

BONE-DENSITY TESTS

For years, physicians have been routinely recommending bone-density tests using dual-energy X-ray absorptiometry (DXA). The test estimates the amount of bone in the hip and spine, which is a marker for osteoporosis. Until recently, women have often been advised to have a “baseline” DXA screening at menopause…then periodically after that.

Problem: Being labeled with “preosteoporosis” (commonly known as osteopenia) can start you on a medical journey of repeated DXA testing and use of medications that may be harmful. For example, osteoporosis drugs known as bisphosphonates—risedronate (Actonel), ibandronate (Boniva) and alendronate (Fosamax)—have been shown, in rare cases, to cause an unusual fracture of the thigh bone when one of these medications is taken for longer than five years.

And evidence shows that this test is not always a reliable predictor of fractures even in high-risk patients who are already receiving drug therapy for osteoporosis.

New thinking:

  • Unless you are a woman age 65 or older or a man age 70 or older—or you have a special risk factor for osteoporosis, such as family history, smoking or alcohol abuse or use of corticosteroid drugs—you probably don’t need DXA screening.
  • If your DXA test results show that you have normal bone mass, you don’t need to be tested again for up to 10 years, provided you don’t break a bone or show other signs of osteoporosis, such as losing more than an inch in height.

Carotid Artery imaging

Your carotid arteries carry blood from your heart through the neck to your brain. If those arteries become narrowed from a buildup of plaque (a condition known as carotid artery stenosis, or CAS), your blood flow is slowed and your risk for stroke increases. Doctors can use ultrasound, magnetic resonance angiography (MRA) or computed tomography angiography (CTA) scans to check for plaque in these arteries.

Problem: If testing does show a blockage, you may be advised to take medication that won’t necessarily improve your life expectancy. You may even be urged to undergo surgery (endarterectomy) to clear the artery. However, this is a difficult and complex operation that in rare cases leads to stroke, heart attack or even death.

New Thinking :

  • Unless you are experiencing symptoms, such as stroke, transient ischemic attack (a so-called “mini-stroke”) or unexplained dizziness, you probably do not need to be screened for CAS. Evidence shows that the harms of screening (and subsequent treatment) in people without symptoms usually outweigh the benefits.

If you do undergo screening for CAS, surgery is generally not recommended unless you have more than 70% blockage in one or both of your carotid arteries and you have had a stroke or ministroke in the previous six months.

EKG AND STRESS TEST

During your routine physical, your doctor may have ordered an electrocardiogram (EKG or ECG) to measure your heart’s electrical activity and/or a cardiac stress test to check the same functions but under conditions where you are “stressed” via exercise or medication.

Problem: Unnecessary stress testing can lead to false-positive tests—indicating that something is wrong when you are actually healthy. This can mean more follow-up tests, including CT scans or coronary angiography, both of which expose you to radiation. And in rare cases, an angiography actually leads to a heart attack in people who have the test. Sometimes, after a “bad” EKG or stress test, a doctor may also prescribe unnecessary heart medication.

New thinking:

  • If you don’t have any heart-related symptoms (such as chest pain or shortness of breath), the evidence shows that an annual EKG or other cardiac screening is unlikely to prevent a heart attack, catch a hidden heart problem or otherwise make you any healthier than you already are.
  • If you are getting noncardiac thoracic surgery (for example, on the lungs, esophagus or other organs in the chest), you do not need to have stress testing before the operation unless you have a history of heart problems. In healthy patients, testing rarely changes how they are treated, so it’s generally not necessary.

*The tests in this article are evaluated at ChoosingWisely.org, a Web site that advises patients and doctors on a wide range of tests and procedures. Developed by more than 50 medical specialty societies, such as the American Academy of Family Physicians and the American College of Surgeons, the information is based on the most current scientific evidence. Remember to check with your doctor for advice that’s tailored to your specific needs.