Do You Really Need That Test?

Do You Really Need That Test?

If your doctor says you need a medical test, such as an MRI for non-specific lower back pain that you’ve had for less than six weeks, a blood test for T3 (triiodothyroidine level) in the case of hypothyroidism, or a CT scan for an uncomplicated headache, chances are you’re going to have it done. But that may be a mistake. Not every test your doctor orders is necessary for diagnosis or effective treatment. Some of these services offer most people little or no benefit, and they can, in some cases, cause physical and/or emotional harm. Plus, they amp up health-care costs.

According to a study in JAMA Internal Medicine that looked at 28 low-value procedures, there’s widespread overspending on healthcare. The researchers say an estimated $780 billion is wasted on healthcare every year in the U.S.; $200 billion is spent on overtreatment, while low-value services steal $32 million annually.

What’s fueling this runaway impulse to test, test, test? Doctors don’t wait to see if the problem improves over time, or they go along with a patient’s request for a test. Also, a survey of doctors at one hospital found that 28 percent of the tests and procedures they ordered were at least partially for protection from being sued.

So here are some commonly over-prescribed health services. If your doctor orders any of these, ask what benefit they’ll provide YOU.   

Imaging for lower back pain
For patients with lower back pain, there’s only a 5 percent chance that the cause is serious damage to the spine. Scans are expensive and, in the case of a CT scan, expose you to radiation that could increase your cancer risk. Your doctor can probably figure out what’s going on by asking you focused questions about your pain and then recommending physical therapy or lifestyle changes. You are as likely to get a benefit from an MRI or CT scan in the first six weeks after onset of lower back pain as you are from petting a greyhound. Pet the greyhound!

When it’s smart: If you’re experiencing one or more of these red flags, a scan could reveal a bigger problem, like a herniated disc, spinal fracture, infection or cancer:

  • A fever over 102° F
  • Loss of control of bowel or bladder
  • Loss of feeling or strength in legs
  • Problems with reflexes
  • A history of cancer
  • Six weeks of physical therapy with no improvement

Head scans for headache
Most headaches, including migraines and cluster headaches, aren’t a sign of an underlying disease. Again your doctor may figure out the cause of your headache by asking you questions and doing a physical exam. Still, one study found that 17 percent of CT scans for headache were ordered because the patient wanted it or the doctor was concerned about legal consequences.

When it’s smart: A scan may be necessary if you have any of the following signs:

  • A headache that feels like something is bursting inside your head
  • A headache that’s different from others you’ve had, especially if you’re 50+
  • Headaches after exercise
  • Headaches with symptoms such as loss of control, seizure, change in speech or alertness

EKG/nuclear imaging stress test for heart disease
Other studies have looked at specific tests and found even greater indications of wasted money—and exposure to potentially risky substances. In 2014 in the Annals of Internal Medicine researchers found “between 1993 to 1995 and 2008 to 2010, the annual number of U.S. ambulatory visits in which a cardiac stress test was ordered or performed increased from 28 per 10,000 visits to 45 per 10,000 visits (85 percent included imaging).” Their conclusion is breathtaking: “At least 34.6 percent were probably inappropriate, with associated annual costs of $501 million and 491 future cases of cancer.”

When It’s Smart: If you do have heart disease risk factors such as chest pain, shortness of breath, irregular heartbeat, heavy heartbeats or a history of heart disease, you’re a good candidate for an EKG. 

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