THURSDAY, Dec. 29 (HealthDay News) -- If you've had a medical
procedure lately, you probably first had blood tests, an imaging
test like an MRI or ultrasound, perhaps an electrocardiogram and
"Is all this really necessary?" you might have wondered.
That's a question that doctors themselves are now raising as a
growing body of evidence suggests that overuse of diagnostic
testing may be harming patients' health and driving up health-care
"There is clear overuse or misuse of certain kinds of tests for certain patients," said Dr. Steven E. Weinberger, executive vice president and chief executive officer of the American College of Physicians.
So should doctors exercise more restraint, or should patients
take a more active and skeptical role in their care?
Weinberger believes the answer lies somewhere in the middle.
"There needs to be an honest conversation in both directions, with
a clear understanding about what is and isn't necessary," he
Experts agree that excessive testing is costing the U.S.
health-care system billions through waste. Weinberger said that
some estimates have suggested the cost could run as high as $200
billion to $250 billion a year, an amount equal to about 10 percent
of the total amount spent on the nation's health care.
But the true cost is borne by patients who face increased health
risks associated with diagnostic testing, he said. Dr. Anthony
Shih, executive vice president for programs of the Commonwealth
Fund, a private health policy research foundation, agreed.
"Although most patients are aware that procedures carry some risks, they are less aware that tests carry risks," Shih said.
Diagnostic testing, in fact, carries three main risks,
Weinberger and Shih said:
- Risks directly related to the test itself, such as the
radiation exposure caused by imaging tests.
- The risk for a false positive, which can lead to a string of
other unnecessary follow-up tests and procedures, each with their
own sets of potential health hazards.
- The risk that a condition will be identified that never would
have been clinically significant but now will probably be
A routine electrocardiogram, for example, might identify some
nonspecific condition that leads to a cardiac catheterization, an
invasive medical procedure that carries its own set of health
risks, Weinberger said.
"Unnecessary testing is not necessarily benign," he said. "It can lead to situations that can pose health risks to patients."
Clearly, patients should become more active in asking whether
tests are necessary. But as most anyone who's been a patient can
attest, asking such questions can be daunting for anyone, but
especially for a sick person who needs treatment.
Weinberger said he has personal experience when it comes to the
difficulty of challenging tests as a patient. He recently had
arthroscopic surgery for a knee injury, but before the procedure he
had to undergo a battery of diagnostics that included lab tests, a
chest X-ray and an electrocardiogram -- all unnecessary, as far as
he could tell. And yet, he had the tests without questioning
"My experience shows you how hard it is," Weinberger said. "If there's anyone who was in a position to question these tests, it's someone like me." But, he admitted, "you don't want to antagonize the person who's going to provide your care. Sometimes the easiest road is to just go along."
His organization, the American College of Physicians, has
started tackling the issue through what it calls its High-Value,
Cost-Conscious Care Initiative, which aims to reduce unnecessary
testing by educating physicians and patients alike on the benefits,
harms and costs of tests linked to specific ailments.
"We're basically trying to develop a list of those types of things that are overused and explore the evidence behind why they are overused," Weinberger said.
Shih said that people who are facing diagnostic tests should use
such resources to educate themselves and then feel free to question
their doctor about the tests that have been ordered.
"The patient should always ask what the test is looking for, what the potential harms are for the test, and what the next steps are if the test finds something," he said. "As the tests get more invasive and more complex, I would be more careful about asking for the reasoning behind each test."
Ultimately, however, both patients and doctors need to keep in
mind that the necessity of tests is a very specific and personal
matter, Shih added.
"It's important to recognize that for any given patient, even with the exact same condition, the decision may not be the same," he said. "It depends on the values and preferences of each patient."
"Some patients want to be absolutely sure, while other patients may be more comfortable with uncertainty," Shih explained. "There is no hard-and-fast rule for which tests might be appropriate for each situation."
The U.S. Agency for Healthcare Research and Quality has more on
with your doctor.