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Medical Tests You Don't Need
Unnecessary medical tests drive up the cost of health care; in fact, the American Board of Internal Medicine (ABIM) Foundation says unnecessary testing accounts for up to 30 percent of the cost of health care in the United States. Unnecessary tests also can cause false diagnoses – and unnecessary stress.
In an effort to identify and curb unnecessary medical tests, the ABIM Foundation asked doctors in nine medical specialties to identify tests or procedures that are used too often or are usually unnecessary. Their suggestions include:
Healthy people with no symptoms of heart disease do not need annual EKGs, stress tests and other cardiac screening. There is little evidence that these screenings of healthy people have any impact on long-term health. However, they can cause false diagnoses, which can lead to unnecessary and invasive – and expensive – procedures that can themselves carry risks.
Doctors should not routinely prescribe antibiotics for sinus infections. Although most sinus infections are caused by viruses, and thus do not respond to antibiotics, doctors prescribe antibiotics in 80 percent of cases. This is expensive and can lead to patients developing a resistance to antibiotics. Antibiotics should be prescribed only if nasal secretions are discolored and the face or dental area is tender to the touch.
Imaging, such as MRIs, is not necessary for most low back pain for at least the first six weeks. Low back pain is the fifth-most-common reason for a trip to the doctor, but imaging is not called for in the first six weeks unless there are “red flags,” which include severe or progressive neurological problems or the presence or suspected presence of a severe underlying problem.
People with uncomplicated headaches do not need CT scans and other imaging. Even severe headaches do not require scans unless the patient also has other significant symptoms. Unnecessary scans can lead to misdiagnosis. They also increase exposure to radiation; half of all radiation exposure comes from medical procedures.
Routine chest X-rays for people being admitted to the hospital or prepped for surgery are not required unless the person’s medical history or exam suggests a reason for the X-ray.
People who have had a normal colonoscopy exam do not need another exam for 10 years.
Doctors should not use PET, CT or radionuclide bone scans in treating early stage prostate or breast cancer. There is little evidence that these tests improve survival, and they can lead to “unnecessary invasive procedures, over-treatment, unnecessary radiation exposure, and misdiagnosis.”
Check for suspected appendicitis in children with ultrasound before using a CT scan. Ultrasound is almost as effective in identifying appendicitis, and it reduces the child’s exposure to radiation.
Of course, you should talk to your doctor about any tests or treatment he or she recommends. But in general, you should ask if a test is truly necessary, if it is approved and supported by medical evidence, if it duplicates any other tests you already have had, and it the test itself can cause harm. Then you and your doctor working together can decide what tests are right for you.
For more information on the ABIM Foundation’s Choosing Wisely initiative, go to choosingwisely.org.