April 13, 2016

Is This Test Necessary?

“Let’s order some tests,” is a phrase heard countless times everyday in a doctor’s office or hospital. Whether your back hurts, you have a cough, your head aches or you’re about to have surgery, you may think that an X-ray, MRI or CAT scan will help identify or rule out problems quickly and painlessly.

In reality, it’s not quite so simple. Many medical tests are not only not necessary, but they can lead to greater health problems down the road while driving up the cost of health care astronomically.

A report issued by the Institute of Medicine in 2010 estimated that each year $750 billion in health care spending is wasteful. The largest contributor to that wasteful spending is unnecessary tests and procedures.

The ChoosingWisely® website, sponsored by the American Board of Internal Medicine (ABIM), is a useful tool to help doctors and patients decide what medical services are scientifically valid, medically necessary and not harmful.

A report found there on low back pain reveals that the American Society of Physicians and four other highly-respected medical specialty societies recommend against the use of imaging tests for generalized low back pain without serious complicating factors, at least for the first six weeks. Within that time period, most low back pain will resolve itself through simple, non-invasive, treatments such as over-the-counter pain or inflammation relievers, heat and exercise.

The report cites studies that show, “Routine imaging can subject patients to unnecessary harm, by finding abnormalities that are not clinically relevant that lead to further downstream testing, spinal injections, and in some cases, surgery. Imaging studies may also cause unnecessary exposure to radiation…One study estimated that patients who received an MRI during the first month of back pain were eight times more likely to have surgery and experience a five-fold increase in medical expenses with no observed gains in recovery time as compared to patients undergoing no imaging.”

Why do doctors continue to order X-rays, CAT scans and MRIs for nonspecific low back pain when they are proven to be unnecessary, harmful and wasteful? One reason is patient demand. Too often, patients demand tests that are not in their best interest. The same holds true for medications. For example, many patients demand antibiotics from their doctors for viral infections that those medications don’t help and whose overuse can be harmful in the long run.

Another reason is that, in this age of on-line patients’ reviews and comments, physicians want to protect their reputations and ratings. The ChoosingWisely® report says, “Experts feel that they are never penalized by patients for ordering imaging tests that are unnecessary, but receive negative ratings when a patient expects imaging and does not receive it.”

The best way to avoid unnecessary tests and procedures is to talk with your doctor about what he or she is prescribing and why. Don’t be afraid to ask questions. “Is this test necessary? If so, why? What will happen if we do nothing? Is there another test or medication that carries a lower risk or costs less?” These are all valid questions and your doctor should take the time to answer them fully.

Medical tests can not only be useful, but lifesaving, when used appropriately. It’s up to you and your doctor to decide which services and treatments are best for you and your family. For more tips on how to communicate with your doctor and what to bring to your appointment, visit MyHealthWI.org.