Experts point to overuse of screening and diagnostic tests

"First, do no harm." That's a fundamental principle taught to medical students and upheld by doctors in practice. It means that doctors should not risk an intervention—including a medical test—if its outcome has a higher chance of doing more harm than good to a patient.

That dictum should ease your mind about the necessity of a test if your doctor orders either a screening (to detect evidence of a disease when you have no signs or symptoms) or a diagnostic test (to determine the cause of symptoms or monitor a disease's progress). It turns out, though, that you may want to question the wisdom of undergoing certain tests and get assurance from your doctor that a test is really needed. Health care experts are beginning to recognize that some tests are overused and may expose patients to unnecessary risks and anxiety.

What's more, test overuse contributes to rising health care costs, putting undue burdens on patients, employers, doctors and health care systems. Insurers are forcing patients to pick up more and more health care expenses, including those for medical tests, that can hit you hard in the pocketbook.

How do you know when to ask your doctor whether a test’s health benefits justify its costs and any potential harm? The American College of Physicians published in the January 2012 issue of Annals of Internal Medicine a list of 37 commonly prescribed screening and diagnostic tests that aren't always used judiciously—that is, the tests don't always promote patient care and may have adverse consequences.

Some of these tests can yield misleading results, prompting more unnecessary tests, invasive procedures or treatments. For example, ordering an exercise stress test for someone who doesn’t have heart disease symptoms can lead to inaccurate findings (false positives), which can trigger follow-up invasive cardiac catheterization or an unneeded computed tomography (CT) scan. CT scans in general are earmarked as problematic since they're commonly overused and expose patients to potentially cancer-causing radiation.

Other organizations are following suit. In April 2012, nine major medical associations released a list of 45 tests and treatments often misused, as part of an American Board of Internal Medicine (ABIM) campaign called "Choosing Wisely." The campaign's goal is to provide specific, evidence-based recommendations that doctors and patients should discuss to help make wise decisions about the most appropriate care based on their individual situation. The ABIM report appeared in The Journal of the American Medical Association.

An overused test doesn't mean it should never be used. But ask your doctor whether the test is necessary, what it will likely cost and how it will improve your outcome. To see complete lists of the tests, visit www.annals.org/content/156/2/147/ T1.large.jpg and www.choosingwisely.org.

Doctor's Viewpoint

Simeon Margolis, MD, PhD, Professor of Medicine & Biological Chemistry, Johns Hopkins School of Medicine

I applaud the organizations behind both initiatives for creating a beginning list of unneeded tests and the Choosing Wisely campaign. I've felt for a long time that unnecessary medical tests contribute to the excessive costs of medical care. More care is not necessarily better care.

Patients should query their doctors about tests—asking whether they're necessary, if they can improve or modify their care and if there will be any ill effects. The initiatives should help foster a better dialogue between doctors and patients—and help contain costs.

Source: Prepared by the Editors of The Johns Hopkins Medical Letter: Health After 50

Publication Review By: the Editorial Staff at Healthcommunities.com

Published: 18 Jul 2013

Last Modified: 18 Jul 2013