It’s common knowledge in medicine: Doctors routinely order tests on hospital patients that are unnecessary and wasteful.
Some experts estimate that at least $200 billion is wasted annually on excessive testing and treatment. This overly aggressive care also can harm patients, generating mistakes and injuries believed to cause 30,000 deaths each year.
Medicine is often a numbers game. Unnecessary tests and treatments do not add value to care. In fact, they can potentially be hazardous to the health of patients. For example, X-rays and CT scans expose patients to potentially cancer-causing radiation, and can lead to follow-up tests and treatment with additional risks.
Here are the five examples:
1. ECGs (electrocardiograms) – The problem: An ECG records the electrical activity of your heart at rest. It provides information about your heart rate and rhythm, and shows if there is enlargement of the heart due to high blood pressure (hypertension) or evidence of a previous heart attack (myocardial infarction). The risks: The ECG will not harm you. However, it can sometimes show mild nonspecific abnormalities that are not due to underlying heart disease, but cause worry and lead to follow-up tests and treatments that you do not need.
When to consider the tests: You may need an ECG test if you have risk factors for heart disease such as high blood pressure, or symptoms such as palpitations or chest pain. Or you may need it if you already have heart disease.
2. Imaging tests for lower-back pain – The problem: Getting an X-ray, CT scan or MRI may seem like a good idea. But back pain usually subsides in about a month, with or without testing.The risks: X-rays and CT scans expose you to radiation, which can increase cancer risk. 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 even including surgery.
When to consider the tests: X-ray and CT scans often make sense if you have nerve damage, or signs of a serious underlying condition such as cancer or a spinal infection. “Red flags” that can alert your doctor that imaging may be worthwhile include a history of cancer, unexplained weight loss, recent infection, loss of bowel or bladder control, abnormal reflexes, or loss of muscle power or feeling in the legs.
3. CT scans and MRIs for headaches – The problem: Many people who have headaches want a CT scan or MRI to find out if their headaches are caused by a brain tumor or other serious illness and doctors often comply to provide reassurance. But all that’s usually needed is a careful medical history and neurological exam. Adding a CT scan or MRI rarely helps. The risks: A CT scan of the head uses a low radiation dose. This may slightly increase the risk of harmful effects such as cancer. Risks from radiation exposure may add up, so it is best to avoid unnecessary radiation. The results of your CT scan or an MRI may also be unclear. This can lead to more tests and even treatment that you do not need.
When to consider the tests: They are often warranted if you have an abnormal result on a neurological exam, or if your doctor can’t diagnose the problem based on your symptoms and medical exam.
4. Bone-density tests – The problem: Many people are routinely screened for weak bones with an imaging test called a DEXA scan. If it detects osteoporosis, the results can help patients and their 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 bone-density test gives out a small amount of radiation, but radiation exposure can add up. A diagnosis of osteopenia often leads to treatment with such drugs as alendronate (Fosamax), which pose numerous risks. But there is little evidence that people with osteopenia benefit from these drugs.
When to consider the test: Women should have a DEXA 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 very low vitamin D level, 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.
5. Antibiotics for sinusitis – The problem: People with sinusitis (congestion combined with nasal discharge and facial pain) are often prescribed antibiotics. In fact, 15 to 21 percent of all antibiotic prescriptions for adults are to treat sinusitis. But most people don’t need the drugs. That’s because the problem almost always stems from a viral infection, not a bacterial one—and antibiotics don’t work against viruses. The risks: About one in four people who take antibiotics report side effects, such as a rash, dizziness and stomach problems. In rare cases, the drugs can cause severe allergic reactions. Overuse of antibiotics also encourages the growth of bacteria that can’t be controlled easily with drugs. That makes you more vulnerable to antibiotic-resistant infections and undermines the usefulness of antibiotics for everyone.
When to consider antibiotics: Antibiotics should usually only be considered when symptoms last longer than a week, start to improve but then worsen again, or are very severe.
Remember, I’m not a doctor. I just sound like one. Take good care of yourself and live the best life possible!
The information included in this column is for educational purposes only. It is not intended nor implied to be a substitute for professional medical advice. The reader should always consult his or her healthcare provider to determine the appropriateness of the information for their own situation or if they have any questions regarding a medical condition or treatment plan. Glenn Ellis, is a Health Advocacy Communications Specialist. He is the author of Which Doctor?, and Information is the Best Medicine. A health columnist and radio commentator who lectures, nationally and internationally on health related topics, Ellis is an active media contributor on Health Equity and Medical Ethics. Listen to Glenn, every Saturday at 9:00am (EST) on www. wurdradio.com, and Sundays at 8:30am (EST) on www.wdasfm.com. For more good health information, visit: www.glennellis.com.