When to say ‘Whoa!’ to your doctor

Common tests and treatments you probably don’t need

DOCTORS OFTEN ORDER TESTS and recommend drugs or procedures when they shouldn’t–sometimes even when they know they shouldn’t. In fact, nearly half of primary- care physicians say their own patients get too much medical care, according to a survey published in 2011 by researchers at Dartmouth College.
All that unneeded care can be hazardous to your health–and your wallet. For example, X-rays and CT scans expose you to potentially cancer causing radiation, and can lead to follow-up tests and treatment with additional risks. And the cost can be substantial. A 2011 study found that the price tag for 12 commonly overused tests, such as annual electrocardiograms (EKGs) for heart disease and imaging tests for lower-back pain, was about $6.8 billion.

The problem has become so serious that such groups as the American College of Physicians, the National Physicians Alliance, and a coalition of medical societies have compiled lists of tests and treatment doctors themselves say are done too often. Below are examples culled from those lists.

EKGs and exercise stress tests for heart disease

The problem: For many people, an EKG-which records the heart’s electrical activity through electrodes attached to the chest is a standard part of a routine exam. Some also regularly get an exercise stress exercise test, which is an EKG done as they walk on a treadmill. Both are key if you have symptoms of heart disease or are at high risk of it. But for other people, the tests are not as accurate and can lead to unnecessary follow-up treatment.

The risks: Those follow-up tests can include CT angiograms, which expose you to a radiation dose equal to 600 to 800 chest X-rays and coronary angiography, which exposes you to further radiation. Inappropriate testing can also lead to overtreatment with drugs or even surgery.

The costs: An EKG typically costs about $50 and an exercise stress test about $200 to $300, according to the HealthCareBlueBook.com. Subsequent interventions that are prompted by unneeded tests can add thousands to the tab.

When to consider the tests: An EKG and exercise stress test should often be ordered if you have chest pain, an irregular heartbeat, or other symptoms of heart disease. They can also make sense for people with diabetes or other coronary risk factors who are just starting to exercise.

Imaging tests for lower‐back pain

The problem: Getting an X-ray, CT scan, or MRI can seem like a good idea. But back pain usually subsides in about a month, with or without testing. Back pain sufferers in a 2010 study who had an MRI within the first month didn’t recover any faster than those who didn’t have the test-but were eight times as likely to have surgery, and had a five-fold increase in medical costs.

The risks: One study projected 1,200 new cancer cases based on the 2.2 million CT scans done for lower-back pain in the U.S. in 2007. CT scans and X-rays of the lower back are especially worrisome for men and women of childbearing age because they can expose testicles and ovaries to substantial radiation. Finally, the tests often reveal abnormalities that are unrelated to the pain but can prompt needless worry and lead to unnecessary follow-up tests and treatment, sometimes including even surgery.

The cost: An X-ray of the lower back typically ranges from about $200 to $285, an MRI from $875 to $1,225, and a CT scan from $1,080 to $1,520. Imaging accounts for a big chunk of the billions Americans spend for lower-back pain each year. When to consider the tests: They often make sense if you have nerve damage or signs of a serious underlying condition.

Red flags can include a history of cancer, unexplained weight loss, recent infection, loss of bowel control, urinary retention, or loss of leg strength.

Bone‐density scans for low‐risk women

The problem: Many women are routinely screened for weak bones with an imaging test called a DEXA scan. If it detects outright osteoporosis, the results can help you and your doctor decide how to treat the problem. But many people learn they have only mild bone loss, a condition known as osteopenia, and for them the risk of fracture is often quite low.

The risks:
A diagnosis of osteopenia often leads to treatment with such drugs as alendronate (Fosamax) and ibandronate (Boniva), which pose numerous risks. Those include thigh fractures, throat or chest pain, difficulty swallowing, heart-burn, and more rarely, bone, eye, joint and muscle pain, bone loss in the jaw, and possibly abnormal heart rhythm. But there is little evidence that people with osteopenia benefit from the drugs.

The costs:
A DXA scan costs about $132. The price for a month’s supply of generic alendronate is $38 to $70, and $125 to $148 for Fosamax, the brand-name version. People often take the drugs for years.
When to consider the tests: Women should have the scan at age 65 and men at age 70. Younger women and men ages 50 to 69 should consider the test if they have risk factors such as a fracture from minor trauma, rheumatoid arthritis, low body weight, a parent who had a hip fracture, or if they have used corticosteroid drugs for a long time, or they drink excessively or smoke. Whether follow-up tests are needed depends on the results of the initial scan.

Ask these Questions:

Do I really need this test or procedure? The answer should be direct and simple. Tests should help you and your doctor decide how to treat your problem, and procedures should help you live a longer, healthier life.

What are the downsides? Discuss the risks, the chance of inaccurate results or the need for further testing.Weight the potential complications against possible benefits and symptoms of the condition itself.

Are there simpler, safer options? Sometimes lifestyle changes will provide the relief you need.

What happens if I do nothing?
Ask if your condition may worsen- or improve if you don’t have the procedure now.

How much does it cost? Ask whether there are less expensive alternatives for procedures and medications.

The above article was reprinted from the Consumer Reports Choosing Wisely Campaign. Choosing Wisely aims to promote conversations between doctors and patients by helping patients choose care that is:

  • Supported by evidence
  • Not duplicative of other tests or procedures already received
  • Free from harm
  • Truly necessary

Information from Consumer Reports is for you to use when talking with your health care provider. It is not a substitute for medical advice and treatment.

The full library of Choosing Wisely reports and interesting patient stories is available at consumerhealthchoices.org/Minnesota