Unnecessary medicine: Physician groups list 45 overused tests, procedures

[mfcorey1]

snip


"Unfortunately, in some of the political rhetoric about health care costs and all of the accusations about rationing, consumers get understandably worried," said Dr. Christine Cassel, president of the American Board of Internal Medicine and ABIM Foundation, which organized the Choosing Wisely campaign.

Patients "think more is better, and 'Maybe I'm not getting something I need,' when, in fact, more is not necessarily better," she said. "There are a number of things that not only aren't necessary and are potentially costly, but also have a risk of harm to the patient."

The lists cover a wide range of tests, procedures and treatments, some of which are routinely used for thousands, even millions, of patients. Others are only for specific kinds of patients such as those with certain cancers or undergoing kidney dialysis.

For example, the American Society of Nephrology said dialysis patients with limited life expectancies — six months or less — and no signs or symptoms of cancer shouldn't get routine cancer screening, including mammograms, colonoscopies, Pap smears and PSA tests.

The American Society of Clinical Oncology, which is meeting in Chicago this week, recommended against using advanced imaging technologies such as PET, CT and radionuclide scans to determine cancer spread in patients with early-stage breast cancer and prostate cancer that is at low risk of metastasizing.

In both cases, the tests can lead to unneeded invasive procedures, overtreatment, unnecessary radiation exposure and misdiagnosis.

Some outside experts applauded the effort to reduce unnecessary care.

"The greatest advance in medicine in the past 50 years is not the latest wave of good ideas. It's the ability and mandate to ask whether any idea advantages any patient, and if so, how much?" said Dr. Nortin Hadler, author of "Worried Sick: A Prescription for Health in an Overtreated America."

"These lists scratch the surface of good ideas that have proved disappointing at best," Hadler said. "Every patient has the right to ask a physician 'How certain are you that any particular test or intervention will advantage me?' and expect an informative answer."

Others said the campaign has shortcomings.

http://www.sun-sentinel.com/health/ct-met-unnecessary-medicine-20120404,0,1209636.story

[Ilsa]

1. They'll have to add transvaginal ultrasounds for women seeking abortions. nt

[Honeycombe8]

2. Colonoscopy! Have you noticed that it's the current en vogue test these days?

My dear, just EVERYONE is having one!

[emilyg]

3. Glad I had one - found

cancer and God willing it's all out after my surgery.

[Honeycombe8]

9. Glad you did the right thing...for you. But for some people, they're unnecessary.

But just everyone who's anyone is having one these days.

In actuality, even the American Cancer Society doesn't recommend one for everyone. They recommend getting one of several kinds of tests, unless you fall into one of the risk categories.

Stopping eating beef would actually go further in preventing cancer, which is really the goal, right? But when's the last time your doctor authoritatively told you you need to quit eating beef because it causes cancer? But I'm SURE the dr authoritatively told you you need to get a colonoscopy at the hospital he's affiiliated with, by a dr. there that he routinely refers people to, at an exorbitant cost. Stopping the eating of beef is free and doesn't benefit the medical community, so you won't be hearing your dr. tell you that. In fact, if you stop eating beef, you'll COST the medical community in lost profits because you'll be healthier. You'll be less likely to get colon cancer or heart disease.

I get one of the several tests. I am not in any of the risk groups. No one in my family has ever had colon cancer. I'm a semi-vegetarian. I try to exercise regularly. Nothing in my tests or my lifestyle or genetics indicates that I will ever get colon cancer. So I won't be getting a colonoscopy. And that is in accordance with American Cancer Society guidelines.

But I am bombarded from drs and friends with "recommendations" that I get a colonoscopy. People are shocked! that I haven't had one. I get tired of people telling me I need this hole or that hole invaded by this thing or that thing, to be tested for these things that I am at a very low risk of getting. People are getting carried away with all this testing. Every time a person gets one of these invasive tests or radiology, it is a risk for your health, and in the case of radiology, it does harm although it's a small amount of harm.

Live a healthy lifestyle, don't overdo anything (booze or drugs or sugar), exercise moderately and regularly, and get an annual with reasonable tests for things you're likely to get, and you'll live as long as anyone in your family does. Most importantly, stay away from doctors and hospitals as much as possible. They aren't in the business of prevention.

[emilyg]

11. I don't eat meat. No one in

my family had colon cancer. I'm slim, active. I am 73 and felt my doc did the right thing by me. By the way - I'm a retired nurse.

[Honeycombe8]

13. That's your decision. And your age may be a factor. Anything can happen.

You could get cancer in your sinuses, or a brain tumor, or any number of things. Why not get a whole body scan? Where do you stop? How do you choose the things to get tested? There has to be a line drawn somewhere.

There are several colon cancer tests. It's possible that one of those would've picked up your cancer. I would wonder why he didn't do one of those. Or maybe he did & he saw some results that indicated a possible problem.

It worked out for you. But many people are risking getting their colon punctured, killed from anesthesia, or other things, only to find out they don't have what the doctor knew they almost certainly didn't have. That's my point.

I go by the Am. Cancer Society's guidelines, if they seem to make sense. Those guidelines change from time to time, but it's the best we have for guidelines. It's a benefit vs. risk decision. A colonoscopy has risks. The other colon tests don't, or their risks are less.

[emilyg]

17. I'm not interested in other tests that

"might" pick up a cancer. This is the best test for colon cancer. A mammo 15 years ago picked up my breast cancer.
ith all due respect - I'll continue doing hat my doc and I decide is best for me. If it means tests - that's ok by me.

[Honeycombe8]

19. I can tell you haven't read up on the subject. American Cancer Society has a website...

it describes the tests and gives its recommendations.

A mammo 15 years ago would fall into the ACS guidelines, so women should be having those after age 50, unless you're in a risk category that makes before that age warranted.

Your dr. probably did one of the other tests, or there was a reason he suspected something, to subject someone at your age to a colonoscopy.

[emilyg]

24. I'm through - you are

determined. I shall continue doing hat my doc and I agree on. I have probably read more than you on cancer. Enjoy your day. Each to his own.

[tammywammy]

14. They recommend a colonoscopy every 10 years age 50+ with an average risk

Average risk is everyone that's not "high risk." So they do recommend one at minimum once every 10 years for everyone. More often if you're in a higher risk group or if the every 5 year sigmoidoscopy shows something.

American Cancer Society recommendations:
http://www.cancer.org/Cancer/ColonandRectumCancer/MoreInformation/ColonandRectumCancerEarlyDetection/colorectal-cancer-early-detection-acs-recommendations

Tests that find polyps and cancer

Flexible sigmoidoscopy every 5 years*
Colonoscopy every 10 years
Double-contrast barium enema every 5 years*
CT colonography (virtual colonoscopy) every 5 years*

*Colonoscopy should be done if test results are positive.

[Honeycombe8]

21. As I said, and as you confirm, the ACS does NOT recommend colonoscopy for all

I find it interesting you went to the trouble to actually delete and alter the ACS guidelines, to make it look more restrictive. You deleted the very important "or" in the list of all the tests.

Here's the full list from the ACS site and a true cut and paste:

Colorectal cancer and polyps

Beginning at age 50, both men and women should follow one of these testing schedules:

Tests that find polyps and cancer
• Flexible sigmoidoscopy every 5 years*, or
• Colonoscopy every 10 years, or
• Double-contrast barium enema every 5 years*, or
• CT colonography (virtual colonoscopy) every 5 years*

Tests that primarily find cancer
• Yearly fecal occult blood test (gFOBT)**, or
• Yearly fecal immunochemical test (FIT) every year**, or
• Stool DNA test (sDNA), interval uncertain**

* If the test is positive, a colonoscopy should be done.

** The multiple stool take-home test should be used. One test done by the doctor in the office is not adequate for testing. A colonoscopy should be done if the test is positive.

The tests that are designed to find both early cancer and polyps are preferred IF these tests are available to you and you are willing to have one of these more invasive tests. Talk to your doctor about which test is best for you.

Some people should be screened using a different schedule because of their personal history or family history


***************************************************

As I said, the ACS recommends any one of several tests after age 50. It does NOT recommend a colonoscopy, unless you fall into a risk category (like a positive result on one of the less invasive and less risky tests).

But you wouldn't know that by all the hounding people are getting by drs. these days for people to have colonoscopies. As you can see from the ACS guidelines, you could infer that the ACS is recommending having one of the OTHER tests, and only then, proceeding to a colonscopy if test results are positive. (The only thing the ACS "prefers" is to have one of the several tests that screens for both cancer AND polyps.)

Colonoscopy is the best, and the riskiest. It can result in a torn colon and death, if anesthesia is used. It's not something to take lightly. Esp for one who is not in a risk category or who hasn't had a positive result from one of the less risky tests.

There is a new version of colonoscopy on the horizon, though, that can be done from outside the body, meaning it would be less risky. That would be a good thing and make it more reasonable for more people to have done, if the cost isn't exorbitant.

It's always a benefit vs. risk determination, to be determined by the patient.

[tammywammy]

25. I copy & pasted directly from their webpage and did not delete the 'or'.

I have the link in my post, so anyone can see that I posted exactly what's on their webpage.

They recommend testing to begin for everyone at age 50 that's 'average risk'. Average risk is anyone that's not high risk.

[cherokeeprogressive]

16. A whole buncha people here are glad you had one as well.

Totally on the fence about the whole managed medicine thing when it's couched in the "what's economically feasible" context.

Had a conversation with my Dad, and he said "I don't WANT to live to be a hundred years old..." I asked him what he'd be saying if he were 99 instead of 75. He thought about it for a few seconds... said "You're an ass" and told me if it meant I'd have to change his diapers for ONE MORE YEAR he'd be all about it. We laughed our asses off.

Then he told me He had never really thought about being 99, and if He's lucky enough to get there, DAMN RIGHT He wants to hit the century mark.

Lost a childhood friend to liver cancer after his doctor told him "that's all we can do". Have another close friend who is still alive after HIS oncologist told him his renal cancer was in its last stages. He changed doctors and is going fishing with me on my birthday next month.

NO human being should ever have the authority to end treatment due to economic considerations.

[emilyg]

18. Hugs.

[a la izquierda]

7. Thank god my mom's partner had one at 50...

there was a tumor the size of an orange in there.
If she'd waited, she'd be dying instead of just finishing chemo with no signs of cancer.

[Honeycombe8]

10. Yes, there are people in risk categories who should. But the Am. Cancer Society doesn't recommend

them for everyone. They recommend one of several different kinds of tests, if you are not in one of the risk categories.

Of course, anyone can get hit with just about anything.

But it's very much in vogue these days to get a colonoscopy. Everyone it seems is getting one. And it's really unnecessary for a lot of people.

[tammywammy]

15. And having one at 50 is exactly what the American Cancer Society recommends.

Both my parents had them at 50 and both had quite a few polyps, or as my dad's doctor said "it was a bumper crop."

[a la izquierda]

20. A bumper crop! Bwahaha...

I guess you have to keep a good humor about it!!

My mom got her first one a few weeks ago, as a result of her partner's experience. Luckily, there's zero history in my family, and everything looked good.

[HopeHoops]

4. Yeah, but the BOD has a quota to pay for the machines! Medical advice be damned.

[LiberalFighter]

5. You mean those hospitals that

build new buildings with fancy large atriums, fancy gadgets, provide only single patient rooms, and very expensive medical gadgets?

[HopeHoops]

6. It's much worse than that. Hospital A gets Machine Whatever....

To be competitive, Hospital B gets Machine Whatever when it would make far more sense to transfer the patient to Hospital A for the procedure. Now both have to pay for Machine Whatever and to do so they need quotas. No wonder healthcare costs so fucking much.

[hobbit709]

8. I had one doctor tell me he has to order certain tests in order to get the insurance companies

to pay up on his diagnosis on certain conditions even though they are completely unnecessary for the diagnosis and treatment.

[justabob]

23. yeah, it is bad

I have a client that just moved to Texas from Missouri. She has back issues. The thing that strikes her is the amount of procedures they "have" to do to her, often doing more damage than not. Her Missouri doctors have been horrified by what all she has been subjected to, totally needlessly. I don't know if that is exactly the same thing you are addressing, but it is similar. Isn't this the result (A result) of our once heralded tort reform a few years ago?

edit: typo

[MadHound]

12. And the sad thing is I've seen basically the same article

Ten years ago, twenty years ago, thirty years ago. . .

Putting for profit institutions in charge of our health care system has been a disaster.

[pecwae]

22. The chest xray

prior to outpatient surgery is one I wonder how one would go about refusing. I know it's been the standard prior to any surgery for years. It's done, I suspect, for liability purposes to protect the surgeon and anesthetist. I have turned down some of the other testing that's mentioned, but if I wanted the surgery to be done I couldn't turn down the cxr.