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April 4th, 2012
12:01 AM ET
5 medical tests you often don't needForty-five tests and procedures routinely performed on patients are often unnecessary, according to a report released Wednesday by nine physician groups, the Consumers Union, and the American Board of Internal Medicine Foundation. “Many of the things that are routinely done are things that patients have come to expect and doctors have routinely ordered,” said Dr. Christine Cassel, president and CEO of the ABIM Foundation. “These are not things that should never be done, but they are things that are often overused.” It's more ammunition to ask your doctor whether your tests and treatments are necessary, especially given that patients request many of them. The groups looked at the scientific rational for performing each of the tests and procedures listed in the report. According to the doctors, here are five tests you often do not need: 1. A CT scan or MRI scan after fainting 2. An annual cardiac stress test 3. A chest x-ray before outpatient surgery “There’s good evidence that adding a chest x-ray before you have the surgery doesn’t pick up abnormalities that the doctor needs to know about before the operation,” Dr. Cassel said. 4. A back scan within the first six weeks of lower back pain 5. A repeat colorectal cancer screening The website ChoosingWisely.org lists all 45 tests and procedures featured in the report. It was developed by these doctors' groups along with Consumer Reports and the American Board of Internal Medicine Foundation to help doctors control the cost of U.S. health care. “This is about getting rid of the fat in the system," said Cassel. "Getting rid of waste."
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Get a behind-the-scenes look at the latest stories from CNN Chief Medical Correspondent, Dr. Sanjay Gupta, Senior Medical Correspondent Elizabeth Cohen and the CNN Medical Unit producers. They'll share news and views on health and medical trends - info that will help you take better care of yourself and the people you love. Recent Comments
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What not to get, sponsored by the people paying the bills. It takes three clicks through this "article" to the "ABIM website" to "what is ABIM" to "who runs ABIM" to find out that the guy who is the chair of this organization is also the head of the medicare payment advisory board. That board is a congressional organization created to (wait for it) reduce medicare payments. Are we shocked? Not really. Multiple levels of plausible deniability between the people cutting the money and the people telling you what you "shouldn't" get (which will, of course, become "can't" get).
A more honest story headline would say "People paying for these tests don't like to pay for them". A few are probably ok to skip, but only if we eliminate liability for missing something they would show. Who wants to not do a test and then get sued when the back pain becomes loss of function in the lower legs?
Maybe this country does need a Medicare Payment Advisory Board, if the general populace is too stupid to realize that paying for colonoscopies for 90-year-olds is a foolish waste of money, especially when un- or underinsured young adults are currently going without regular dental care, prenatal care or birth control because they can't afford it or the copays anymore. Funny how most of the Washington DC protestors at the anti-Obamacare riots were Baby Boomers. Don't touch my Medicare! (But it's perfectly OK to deny affordable coverage to working-age adults)
admittedly that one guy MIGHT have some kind of sinister, ulterior motive – but it seems unlikely. Not to mention the fact that 9 other organizations agreed. Lots of doctors complain about the overuse of tests, and cite it as a driving factor for increasing costs.
The reality is that the drug dealing medical community as a whole has been proven to be the most useless industry in the history of mankind. We'd be much better off cutting off all of their funding from the government...
I thought we were all in favor of trying to cut the waste from the health care costs. These are good ways. As a neurologist, I can tell you that it is a complete waste of money to have a CT or MRI of the brain after someone faints. Don't know why emergency rooms often do them. A complete waste of up to a $1000. And it gets done every time. It is much cheaper to examine and talk to the patient. The history when someone passes out is way more important than a CT or MRI. And it costs much less. We do need to try to find real ways to cut the waste. This is a good start.
It's a sad state of affairs when no one... repeat no one, knows who to trust. We hear young people trying to tell seniors that their lives are unimportant and therefore they shouldn't receive the medical care (preventive or otherwise) that is necessary to maintain good health, doctors either trying to CYA or tell patients what the insurance companeis have twisted their and told them to say and fake imported medicine. It's a shame that the country has allowed our country in general and our medical treatment get in this state. It's overwhelming and most people just decide to try to err on the side of safety as much as they can. BTW, back to the seniors, everyone only has one life and that life is precious regardless of the age. To try to tell seniors when to die is discrimination at it's worst. Seniors have a right to live just like those of us in our 20s, 30,s and 40s or any other age. They've paid their dues and now it's time to show a little respect and allow them to get treatment without feeling they are about to tumble into an early grave.
The decision to get or not get any given test is almost always dependent on the specific situation. There are many factors that influence our (doctors') decisions to go ahead and get a test or not. Research like this doesn't dictate what we do, but it does help us make more informed decisions. Ask yourself these questions:
– your patient MIGHT have a brain bleed; do you get an expensive scan and expose him to radiation to rule it out?
-your patient has a 1 out of 10 chance of having a brain bleed; do you get an expensive scan and expose him to radiation to rule it out?
-what if it's a 1 in 1,000 chance? What if it's a 1 in a million chance? One in ten million?
Somewhere the odds of a dangerous bleed become so low that almost everyone agrees the scan is more risk than it's worth. The problem is, we often don't know what those odds are, so we're stuck at "might," err on the side of safety, and get the test.
Research like this is helpful because it can help clarify what those odds really are. We can continue to ignore these kinds of studies and bankrupt the system, or we can try to learn how to help people without wasting their time, money, and exposing them to the risks of unnecessary testing. You're right to always consider the source of new information, but a truly pure study with zero conflicts of interest is a rare thing indeed. Doctors and patients need to work together to understand the limits of what we know and make rational choices based on the information we have. Otherwise, we're just shooting in the dark.
Well said Alex.
To conclude that the chair of ABIM is on the same panel for Medicare advisory and therefore all his statements are suspect? I personally resent that statement. That's akin to saying Obama represents all of Congress.
1) The ABIM is a large umbrella organization under which many, many sub-specialties exist with their own organizations. It is not represented by just a single person.
2) The recommendations came from many specialty boards, each with their own panels and opinions. Not just the ABIM. It only happens that the "Choose Wisely" movement is sponsored by them. For it to sponsor anything is a huge deal, since it's like herding cats.
3) Why on earth would lawyers / legislators ever want to remove liability for tests? When they stand to benefit the most? What really needs to happen is removing the incentive for lawyers in malpractice suits. Then we can talk about what's truly right for a patient.
Sometimes these tests are for the doc's CYA and not for a valid reason. For example, I had a lower back injury while on active miitary service back in the 80's. When I retired the VA awarded me 10% disability for that injury. Over the years it has become increasingly painful for which I need to take a pain killer. However, my family Doc wants an x-ray screening to justify continuing to prescribe a painkiller not for any real diagnostic purpose.
If your having to take pain medication to manage the pain you need to go back to the VA and they need to raise your disability percentage. If you do not ask them to they will not tell you that you may be eligible for a higher disability rate.
Tell your family doc that his fear of being called out for prescribing pain meds is not a good reason to expose you to more radiation. If he's monitoring you and you haven't received any surgery that would cure the problem, he should continue to prescribe them. Maybe he'd be more comfortable if you get a second opinion (again, without new x-rays) to support his decision for continuing meds.
My husband had two back surgeries, but I know they keep an eye on it, as over the years arthritis gets worse. On his last back surgery the doctor told him in 5 years he would be to have his back scraped because of the arthritis build up. Perhaps this is why your doctor wants an x-ray, Or maybe your doctor wants to see how bad the arthritis is to see if you really need painkillers or if you have become addicted to the drug.
The rationing begins and if you don't think so it is your problem not mine.
This is good rationing. It is a total waste of resources to screen more than what this article is stating. And this is good for you too. Why would you want to get a colonoscopy every 5 years if you could get one every 10 years and have each screen be equally efficacious? Why would you submit to unnecessary radiation, and thus raise your own cancer risk, if you did not have to?
You're about 30 years too late, health insurance companies have been rationing for decades.
It's not rationing, it's good, evidence-based medical practice. I do stress tests and no one needs one annually, unless symptoms are present.
My neighbor's walnut-sized, cancerous polyp was just discovered during a colonoscopy. She needs chemo and radiation to shrink it before surgery, in an effort to preserve her sphincter muscle and prevent the need for a permanent colonoscopy. Her doctors are convinced that if she'd had a colonoscopy within the past couple of years, she would not be in this situation. Waiting ten years is too long.
The myth of medical rationing never ceases to amaze me.
You do realize what the word "ration" means, right? Anytime a resource of any kind is limited, we all have to make choices about how to allocate it. If you make those choices rationally, it's called "rationing." We ALREADY ration health care, because it's not an unlimited resource. Right now, we do it with insurance: if you have insurance, you can have a lot of care. If you don't, you can't. Whether or not that's a good way to go about rationing health care is another debate entirely, but the fact is, we already ration health care.
When people shout "No Rationing!" in political discussions, what they're really saying is, "I like the way we ration health care now! I'm happy with the care I get, and I'm not willing to use logic or reason to change the way I consume this limited resource even if it means that I get almost no additional benefit for my wanton spending while tens of thousands of other people go without basic care!" That's a perfectly rational, self-interested position to take and I can't fault you for it–even if I don't share it. Just don't pretend that "rationing" is a new idea.
I agree with Beth that having a Colonoscopy every 10 years is too long. Colon cancer is one of the leading causes of death, As well as, Colon cancer if caught early is one of he easiest to cure. polyups in the colon are slow growing but it's always best to discover them as early as possible. A colonoscopy is not harmful to the body by any means and it isn't even an uncomfortable procedure anymore. It takes rougly a few hours of your time. And when completed and you wake up, You feel as if it hasnt even start yet. Also, if people have a history of Crohn's disease, Ulcerative Colitis of family history of these diseases then a colonoscopy needs to be conducted annually.
Did any of you stop to think there might be something LESS invasive and CHEAPER than a colonoscopy? Something with fairly good detection but can be done far more frequently and safely?
Like checking for blood in your stools (with proper instructions on diet, etc.)?
My heart goes out to the person with colon cancer.
But, that does not replace thinking out more cost-conscious and effective screening / testing strategies with ALL available options (and sometimes developing new ones).
I bet the insurance company CEO's get these tests and are now telling the people who pay their salaries they are not needed. Crooks.
Did you read the article? It's based on what a group of doctors found after reviewing research. It's called evidence-based practice.
Yeah, the insurance carriers would prefer that you get your diagnosis at autopsy. Much cheaper, and only needs to be done once.
Bingo!
I had colonoscopy 5 years ago and had 2 polyps removed, dr. wants me to get another but I dread the thought so you gave me a reason to put it off another 5 years...thank you. 2 years ago had Whipple Procedure done for PC that caused diabetes, and hyperthyroidism I can't image prepping for this test and driving to the hospital the next morning I live alone. I also hate going for a Cat Scan every 6 mths that you also claim is unnecessary. I shall definitely discontinue both of these test thanks to your Wise suggestions.
Sounds like your tests weren't normal, you should probably re-read the article and see what it says in that case.
Agreed with LJ, it appears that if your most recent scope was clean as a whistle you're good to go another 10 years, but if they find and snip something, then your duration between scopes needs to be prudently shortened...
Angie you are not a candidate for every 10 years screening because you had polyps. Even the article says: "Beginning at age 50, one high-quality colonoscopy every 10 years is all you need _if your results are normal_." Your results were _not_ normal, therefore follow your gastroenterologist's advice, which will undoubtedly include more frequent colonoscopies.
Also, if you had a Whipple procedure for pancreatic cancer, the screening recommendations do not apply – follow the recommendations of your surgeon and oncologist.
Listen to your doctor not a reporter. Since you have had polyps you are at greater risk. If your Doctor say come back in 3-5 years listen to him. Some cases can be clear but because of family history you may need to come back sooner than ten years.
Angie – if you had the type of polyps that raise your risk for colon cancer than you would be foolish not to have check-ups sooner than 10 years. The article refers to SCREENING colonoscopy; that is different from your situation, which is called SURVEILLANCE.
Don't worry, Angie. Some of us did pick up on your sarcasm.
I think most readers are missing their sarcasm meters this morning.
Actually Angie you should have a Colonoscopy annually if you had the Whipple procedure...which is a difficult and challenging surgery. Please do not listen to the others advisement in not having these test. Due to have pancratic cancer, you're now potential candidate of getting other medical conditions. Based on what you said. You're now at 50% of getting colon cancer then a person with no history and/or in good health. Colon cancer is slow growing and quite curable if caught in the early stages (stage 1 or 2) or if beign..which can become malginant over time if left untreated. And just to let you know I'm a gastroentrolgist surgeon at Vanderbilt Medical Center. I wouldn't listen to anyone who doesn't have an M.D. or D.O. degree.
Do Not Listen to this article!!!!!! This is very dangerous. 1) We do a scan of your head after fainting to make sure it was not from a bleed, which will kill you if not taken care of immediately. 2) You better have a cardiac stress test if you have cardiac history. Otherwise you are a walking time bomb. 3) Anesthesia will not touch you for surgery if you don't have a recent (within 30 days) set of chest x-ray and blood labs, you do not have the choice to not have a chest x-ray before surgery, and I'm quite glad. 4) You better have some type of imaging on your back once it is injured. It is extremely important to know if you are dealing with or wothout spinal chord impingement- so you can properly treat the problem, without further injuring yourself!! 5) One colonoscopy every 10 years!!! are you kidding me? The person who wrote this article obviously has never seen what colon caNCER LEFT UNTREATED CAN DO TO AN OTHERWISE HEALTHY BODY. aFTER FIFTY, COLONOSCOPY EVERY 3 TO 4 YEARS.
The people who wrote this article are the same people siiting on the other ned of our insurance companies telling us we don't need this or we don't need that, deny, dfeny, deny. Let me decide what I think is best for my patient. Thank you,
Andrew
Excellent post, it should be between you and your doctor as to what type of test are done. Due to anemia I had to have a colonoscopy at age 46. While they didn't find a bleed, they did find 5 polyps that were pre-cancerous. Repeat in 5 years....you betcha, happy about it ...not in a million years.
Excellent post and I have to add that I would feel as though I'm in great & extremely capable hands if you were my doctor.
And they did not mention Family History.
I hear you Timme. Mid 20's and already had a colonoscopy and have been told every 3 years starting from Age 30 due to Family History. Why would anyone want to chance these kind of things anyways? 10 year w/o a colonscopy could mean you already have late stage colon cancer.
Having an MRI or CT Scan for the back pain is not always indicated. There are findings during a clinical examination that can determine whether or not there is spinal cord involvement. Imaging for acute back or neck pain usually doesn't change the course of treatment and does drive up the cost of treatment signigicantly. However if the pain persists, neurological signs are present, and the patient would consider surgery or injections as a form of treatment, then imaging may be warranted. As the rate of recucurrent pain is very high for back patients no matter what the form of treatment, those who receive some form of diagnostic imaging typically dont have any better outcomes than those who dont.
Hello, I think you may have misunderstood some of what the article was getting at and may have some misunderstandings about the nature of these tests/diseases. I am a medical student in my last year of school. I've replied to your points in order to try and explain what is meant by the article.
1) A brain bleed (epidural, subdural, etc) would be low on the differential for an isolated episode of syncope with no residual symptoms and no signs of seizure so in this case a CT scan would be unnecessary and would actually hurt people because it increases your risk of cancer. 2) The article is arguing against routine cardiac stress testing if you have no cardiac history. 3) Actually the point about anesthesia is somewhat true so I won't argue with that, however there is no evidence that these tests save lives if the patient is healthy and has no signficiant medical history. 4) Spinal cord impingement comes with specific signs (hyperreflexia, clonus, etc) and these would prompt an MRI. However, in the absence of significant trauma and neurologic symptoms, there is no need to get imaging initially unless there are red flags. Most low back pain resolves within 4-6 wks, however, many people will have MRI findings of degeneration that may not be causing the pain but end up getting unnecessary procedures due to premature imaging.
5) If you have no family history of colon cancer and have a normal colonoscopy there is NO evidence that more frequent colonoscopies save lives. It takes a while for the colon to go through the changes that result in cancer so if there are no evidence of these changes (polyps, etc) then the likely-hood of cancer is very very low.
Dear "medical student": It is very clear by the post to respond to that the OP is a practicing physician. As a practicing doctor myself, I get a bit cranky when fourth-year medical students try to "respond to my points." finish your internships and residencies, experience some real medical practice outside of an ivory tower and textbooks, and then reply.
Ah yes, the "some is good, more is better" approach to health care. This person is exactly correct. Using reason and evidence to make rational choices is almost never the way to go. Full-body CT scans for everyone! Sure, a percentage of you will get cancer from the scan in 20 years, and a bunch more will be burdened with crushing medical debt that redefines their lives, but hey, this knee's gotta jerk!
to NOVANative. Can your arrogance. The med student is right.
Also a practicing MD.
NOVANAtive, if OP is a practicing physician, I would recommend steering clear of him. He shows no evidence of actually reading the article as intended (screening tests for otherwise healthy people), and his all caps rant doesn't make what he's saying true. Of course there are physical exam findings, family history, and specific situations that would make a physician deviate from the standard recommendations... that's why people go to doctors before getting scans and tests, and don't just get to order them on their own. And that's what they call the art of medicine. There are no guarantees, people will get sick, even die, before their disease can be detected. We could screen every kid with a CBC every three months to make sure we catch leukemia right away, start colonoscopies at the age of 15 and do them every 3 years, and do heart cath's on everyone who has eaten a donut in the past. Are we going to catch more leukemia, colon cancer, and heart disease? Absolutely. Are we going to save some lives? Probably. Are we going to hurt some people by doing a huge number of tests with very little positive effect? Absolutely.
I agree wiith NOVANAtive. He or she is correct when it comes to medical students even in their 3rd yr residencey. I too, am a practicing M.D. and have been for roughly 18 yrs. The med student gave the text book answer.
For the OP, understand the concept of number needed to treat?
Try calculating the costs need to treat. Use that to explain to a patient why you, the lab, and radiology suite are charging $2000 to find nothing without ANY indications.
Then, get back to justifying yourself to the rest of us physicians and the state medical boards.
Especially, when the boards have started stripping doctors of their licenses for INAPPROPRIATE TESTING AND INTERVENTIONS.
So it nhas been 24 hours since I read this article, and I have read it again. I still have the same gutwrenching desire to scream to the public to not believe what they are reading. Unfortunately, our extremely experienced medical students who haven't even spent 1 hour in a damn reidency yet, are ready to go in to private practice.
I think after you take the oath, reach out to your ethics professor and get your feet wet in some 3am icu tlc placement's, it might be best if you commented humbly and kept your opinions where they belong- in your journal.
This article is the type of propaganda that is being used to slowly lead the American public , like mindless cattle, in to a place of indifference towards medicine. This way, when these people pit the average Joe against his doctor- they can make all your healthcare based decisions for you, based on numbers, not giving a crap whether you live or die or how many dependants you may have. This is dangerous!!!!!!!!
One thing to keep in mind is the fact that if I injur my back today, in the USA- and I go to the ER and get seen by an MD and get a MRI and perhaps a script- again- here in the USA, the total cost of the bill for that visit will be about $7,000 including the radiologist's fee for reading the MRI and so forth. If I were to have the same problem and course of treatment in Spain- the total cost would be about $1200. Why is that? Why should the horrific medical inflation factor here in America play a role in how I treat my patients? That is not evidence based practice- that's financial based insuring and it is very illegal. I feel very sorry for the sad state of affairs in western healthcare and western politics right now. Any 3rd year med student who defends this article will surely be looking for a career on the "administrative" end of things, and although we need people to do it- I hope you can see they are slowly training you to not trust yourself and to not care about the individual human you treat. Be careful, "to thine own self be true."
I hate these articles that come across like God's own truth because people believe them and won't have the tests that might save their lives - or the life of a loved one. This article is irresponsible.
I actually enjoy getting tests from my doctor, it reassures me that there is nothing wrong with me. Sure, my doctor might be able to THINK that there is nothing wrong with me, but after a test has been done he knows it for sure. Why do people think that doctors are out to get them?
"Don't get tested, don't get diagnosed. Didn't get diagnosed? WHOOPS! Preexisting condition."
I think that some tests are required, and some abused. I had both. The individual patient has to choose what they actually need. With some doctors it's a business of pushing tests and pills. Other doctors are genuine. You have to make the decision, Getting a CT scan for minor problems or routinely is a good example. I've had about 6 before I read how much radiation they have. It's a vicious cycle how insurance companies refuse procedures and payments and doctors over prescribe. We, the patient, a lot of times are the loser.
People need to read this correctly. I does not say you can wait 10 years to repeat your colonoscopy. it says you can wait 10 years if your colonoscopy was NORMAL. if you have polyps, you should have it done in 5 years, or in some cases in 3 years. also even if your colonoscopy was normal, but your prep was not good, you may need to get it sooner, say 5 years. Colon cancer can develop in 10 years from polyps that were missed or develop in the interim.
If they are so confident why do all these articles use "could", "may not".
"probably not needed"
May want to get attorneys approval before implementing. One small bleed or stroke missed after fainting spell, and patient's phone will be ringing off th hook with calls from lawyers
I had a knee injury years ago. Went to St. Croix Orthopaedics in Minnesota for treatment, and they took an x-ray which was negative. I requested an MRI, and they REFUSED! The doctor said "Your x-ray doesn't show anything is wrong, so we're not doing an MRI". Needless to say, it is now obvious that I had torn meniscus and after all these years of the meniscus grinding away in there, there is nothing left and I need knee replacement. Stay away from St. Croix Orthopaedics if you know what's good for you!
Low and behold the health care industry is found to be over servicing.
In Alabama a neurologist across town did EEGs on every child suspected of ADD...I never could find the justification and considered him a thief.
As a doctor I have to laugh at this. Do you know who these people are who want to limit what your doctor is able to do for you? None of these people actually have a full time medical practice. These are paid government shills.
Notice the weasel words too. "Could" " may" " probably"
It is easy to tell us doctors all these tests are unnecessary. The people making those statements cant get sued for missing something.
So, as a doctor you want to continue ripping off the system by piling needless test upon test when you know with a fair degree of certainty that the test will 1) not reveal anything of importance, 2) raise the cost to the patient/insurance company, 3) only benefit your bottom line?
You are part of what is wrong with our health care system. You would do well as a used car salesman.
Isn't that just an additional problem to the overuse of expensive tests, and not a consideration that should derail cost reduction? This is why I would have liked to see tort reform in the healthcare bill. Malpractice may not be a giant direct driver of costs, but it indirectly drives up costs for the reason you just cited. We should deal with both problems simultaneously.
True. Doctors get sued for missing things. I work in a hospital and I handle a lot fo the malpractice suits that are brought against our doctors and we've had them sued for missing things but we've also had them sued for what the patient considered over testing. The whole idea that you can sue a doctor because you didn't like the outcome of your treatment is ridiculous. There are some cases where it is justified but I swear 98% of the cases we get are total rubbish.
We are in an era where doctors can be sued and stripped of their licenses for also overdoing it.
Coronary angiographies and stenting come to mind.
Careful, Dr. Dude. The pendulum is swinging the other way, too.
These "government shills" are just trying to prevent us from going the other extreme.
Some test or overused for some people.
Like doing bone scans for osteoporosis for a 70 something year old woman who already takes medication for it. The scan won't change the treatment plan or the outcome , so it is a waste of resources.
Doing routine mammograms on the same person , also a waste of resources when that person already has an end stage disease. The Doctors order all of this to cover themselves and , yes to make some extra money sometimes. IMHO this is where the medicare reform needs to come into play.
For the person who had abnormal results – always follow what the MD said. Articles like this are referring to healthy people , not those with preexisting problems.
Wow cookie. I guess you are an expert in osteoporosis among your other accomolishments? I can think of many valid reasons to do a repeat scan on a healthy 70 year old with osteoporosis.
How about we let the lawyer sue you when the elderly lady breaks a hip and dies later in the hospital or nursing home from a blood clot to the lungs? I would say pulmonary embolus, but I suspect you are not the osteoporosis expert you pretend to be so I will use more common words.
You say that these recommendations are only for healthy people, but you also claim that follow-up tests aren't appropriate for people who are already in treatment. Under your reasoning, no one gets health care. Which do you work for: the insurance industry, or the government?
Bine scans are non invasive and takes less then 20 minutes to have one.And they should be done, since there is a medicine that has a treatment that takes 2 yrs and actually grows bones density. So this would have to be monitored. Giving high dose of Vitamin D (8000 IU's daily) is a supplemental course of treatment. Man all these none MD's commenring. When you get your M.D. or D.O. degree and been practicing medicine for a decade then I think your comments would hold some weight. I don't tell atorney's what's best or not best. So leave the doctoring to the people who are professionals in this field. Thanks Dr. of Gastroenrology Surgery @ Vanderbilt Medical Center.
How about this deal?
If I decide not to do a test and miss something let the lawyer sue Dr. cassel. She can risk going bankrupt or losing her career instead of me.
Oh wait. They cant sue Dr. Cassel. She no longer practices medicine. She is a CEO now.
Dude, you've used the word "sue" in every post on this article I've read. That's a problem. All five of these are reasonable recommendations. Being as you are clearl a doctor, you should know that nothing in medicine is 100% true and that's why they say "probably", and the like. And upwards of 80% of lawsuits filed again physicians are in cases that do NOT qualify as medical malpractice, whereas about 90% of actual cases of malpractice never have suits filed. In general, how well a physician is liked is the best predictor of whether or not they will be sued. Good luck to you.
oh, dear, justakid. Dr. Dude is apparently above lay people and the rest of us physicians.
He (since Dude is usually reserved for men) clearly knows best. All his sample sizes of 1 are the best support for evidence-based medicine. And he knows so much about complex issues with study designs and health policies.
We should ask him to run the show and explain to the rest of us his alternatives.
What's that? you have none, Dr. Dude?
Go figure.
At some point these "tests" were not necessary. There must be reasons (likely incidents) that brought these to attention and therefore were deemed necessary.
Every other oil change, or "service", that I take my car in for requires a series of tests and checks that end up costing me close to $200, where the regular oil change is $40. I pay for these ridiculous checks to ensure, if something strange happens with my car, my warranty stays 100% valid.
My point is, we pay some ridiculous expenses in our lives, is our own body where we want to take the risk to save a few bucks. I'd rather my car break down than my heart.
You would think twice if you had to foot 100% of the bill. There are risks, too.
$2000 for an MRI of your back without an appropriate indication? Bad investment. Plus, I find that random spot in your liver, which most of the time isn't nothing. Now, I have to repeat the study and/or send you for a biopsy (sticking needles in you, bunch of anesthesia) to prove it's nothing. What do you mean you don't like that $50,000 outpatient surgery stay?
Nuclear stress test every year? I just upped your chances of cancer and giving you a blood disorder.
Colonoscopy in one year after a previous negative test? Well, when the GI doctor accidentally punctures your colon with a scope, we have a hard time defending him/her for doing it and the doctor ordering it.
Correction:
"which most of the time isn't [anything]"
The fourth reason is absolutely false, I have back problems. I had an X-Ray and an MRI within a week of me having severe back pain. My Chiropractor was able to diagnose and treat a bulging disk, no drugs required...
You all go ahead and ignore your doctor's advice if it contradicts what the CEO quoted in the article says. After all, the CEO of ABIM has your best interests at heart
Exactly; and everyone's medical treatment should be the same, regardless of past history, comorbid illnesses, family history, or other factors such as work history (coal miners vs. cubicle dwellers, etc.). I hope other readers can see the true motivation behind this article, too.
Both of you just changed the conditions, and therefore the premise, for the statements in the article.
Then, declared the statements false.
So much for understanding logic, much less science, through medical school training in these two.
Test 6: Getting your patience tested by the admittance nurse is not needed either.
I know a 60 year old who was having the pre-op for knee replacement surgery when they found she had stage 3 lung cancer. With stage 3 there may be effective treatment, but if not for that chest X-ray, it would have been Stage 4 shortly and then it would have been her life. I don't see any way they can justify eliminating that part of a pre-op. It's clearly wreckless disregard for human life.
Most smart doctors and will not perform a surgery without the pre-op protocols which is a CBC, other blood work up if necessary and chest x-rays. It's a precaution but you want ensure your patient is a surgical candidate. Once had a patient I refused to operate on due to being too malnourished. Instead the patient needed a picc line to bring up those nourishment levels to ensure they could withstand a 3 hour surgical procedure.,,which was an temporary ileostomy. After 10 weeks the operation was performed. SO, what Dr.Dude is saying is correct. Most doctors have their patients best interest at heart. Insurance companies see a sick person as a liability and a health person as an asset bring in revenue to their company. Insuracne companies rememeber are in this business to "MAKE PROFITS."
Spoken like a true surgical jock.
Really? It happened to a friend.
#1 and # 5 are completely false and I urge people not to listen to them. Colon cancer can grow quickly like most cancers and 1 check every 10 years is basically useless unless when you get checked it jsut started growing.
Many people are posting here about their individual stories of a time a test wasn't done and things turned out badly. Therefore, the reason goes, you should always get the test. That's a very natural way to think about things, but it's not how science or medicine works. Think about in terms of other every day decisions you make:
– You decide to buy a plan ticket. You know that some people die in plan crashes, but you know the chances are very small so you fly anyway.
-You're friend tells you, "I know a guy who flew last year and his plan crashed! You should never fly!"
– You're sad for your friend, but you also know that this new bit of information doesn't really change anything about YOUR choice to fly. Maybe it gives you pause, but you know your odds of crashing are exactly the same now as before you heard the sad, personal story. Do you cancel your flight?
I think most people don't. I think most people accept that there is always a small chance of "badness" no matter what choices you make, so all we can do is try to optimize the odds. That's what studies like this one do; they help us figure out the real chances of badness so we can make smart choices.
I would LOVE to encounter a doctor who would order a test as a precaution. Every medical professional I've encountered makes me wait until I'm half-dead before ordering a test. I guess those are the docs that the people footing the bill prefer.
Here's what's wrong with this system. The AMA has said up to 30% of all MRIs are medically unnecesary. So when I had a cardiac arrest leat year, $38,000.00 worth of tests failed to find the cause althoughtI said all along it was dehydration. But if you refuse the testing the insurance comapny won't pay for anything and I already had an ambulance ride. The providers abuse the system and that's why medical services cost soooo much!
Eliminate the fear of frivolous malpractice suits for missing an unforeseen diagnosis and the problem of over-ordering tests will be solved.
What a great day – doctors are asking #2 of our 5 questions: Is this really necessary?
Find 4 more questions that could change the health care culture: http://whatstherealcost.org/video.php?post=five-questions
So a colonoscopy is necessary every 10 years now instead of 5. That's great news. It's a real pain in the butt.
The system is the fat. Get rid of the "system" and everything else will fall in place.
if they would just pass tort reform the docs would not be so scared of law suites and be able to practice medicine. the cost of medical care would go way down for everyone.
What's the incentive for malpractice insurance to do that? The threat leads them to charge higher rates.
What's in it for the lawyers and legislators who make money of these cases? Truth and justice be damned by them.
What's in it for the media who gets to sell a scandal? Ethics is scarce among all so far mentioned.
How does a doctor protect his/her reputation after the ordeal? Some cases lead to stripping them of their license and livelihood. Many are effectively tarred and feathered before the rest of their peers.
Notice how tort was strangely absent when President Obama presented his healthcare reform?
This is abot getting the insurance companies out of having to pay up. What the article doesn't mention (especiall in the colorectal screenings) is that if a person has a family history of colorectal cancer. The screenings should be done every three years. There is a serious danger in making such broad based generalizations about medical treatment.
I disagree with the CT or MRI after you hit your head. Even though you may not have any seizures, this doesn't mean that you might have internal bleeding in the brain. Of course, this depends on how hard you were hit too. We all remember that skier who fell down and seemed to be fine, until suddenly he/she fell down and died. This is the reason you want to get a scan; just to be safe.
I am the first person at the doctor's when something ain't right, but if a 'routine' test is unlikely to improve diagnoses and treatment, or have a demonstrable, positive effect in my survival outcome, then it is, by definition, unnecessary. All radiographic imaging increases your exposure to radiation (duh) and all invasive tests carry the risk of bleeding and infection. The point is to choose your risk wisely! The more testing (i've had plenty), the greater the risk. And no, I don't work for an insurance company. I was a cancer patient.
Well, that proves it folks – is there any wonder we can't reform health care. Bottom line from little-'ol'-me. Health care should NOT be connected to our jobs – it should be connected to us, as people - including children - including the geriatric crowd. If you can't or don't trust your physician -if that physician isn't have conversations with you that help you decide on the medical care that suits you – then you need a new physician. Easy-peasy.
Im a x-ray, cat scan and ultrasound tech. You wouldn't believe how much radiation is delivered in a cat scan. An average cat scan delivers about 3 years worth of radiation from the sun in from a two minute scan. Doctors rely on cat scan like a crutch, especially ER doctors. Sometimes if the ER doctor can't read an x-ray so they will order a ct scan just so they can have a radiologist read it. I won't be suprised if young people years from now have cancer, doctors order way too much just to please the patient or a paranoid patient. ER doctors mainly order way too much radiology exams to cover their butts so they won't be sued in case they missed something.
Cover your As* medicine, and that is never ok.
Yes, keep telling people that they do not need medical tests and drive up the number of people who will die of cancerous tumors, parasitical infections, and serious illnesses.
No one has a crystal ball, if we believe you every one should have a head to toe scan every 6 months/ year and we will find every possible tumor and we will become immortals.
This is a very welcome step towards generating awareness about waste in medical care. However real change in practice is unlikely unless tort reforms are implemented. Er docs who order CT scan every time someone come after a faint are also doing what is called "covering their a**". Nobody wants to get sued and as long as there are greedy lawyers out there to manipulate patients to extort money from doctors and hospitals and the later have no way to defend themselves, they are going to hide behind the tests and scans.
A patient should always speak to their Doctor. Before deciding to not have a test done, they should have the doctor explain why the test is necessary. My doctor last June wanted me to get a CAT scan. He waited a few minutes before recommending it because he had first gotten every detail he could about the chronic migraines that had crippled me for over a month.
I agreed.
That CAT scan showed Scars that were highly probable to be MS... so to the neurologist I went. One full spinal MRI and a Lumbar puncture later, and the St. Lukes neurology department was confident that MS was the culprit. Without that initial CAT scan, I could have gone years without treatment, until a bad relapse did something permanent and awful. I'm happy it was found now, while I'm young and able to take medication for it.
The only bad part being that now I'm flagged for MS, and insurance will get ridiculous. My meds are 3600 a month, which fortunately is covered by my husband's tricare. But when he gets out? What then? Do I go without my meds, or do I hope that something affordable is put in place for me?