October 25, 2011

Other Healthcare Tests and Procedures Under Scrutiny. What Should YOU Do?

Yesterday, I discussed the uproar over -- and my own uncertainty about -- the federal task force recommendation that men not get the PSA test for prostate cancer. I had my cancerous prostate removed in 1995, and have been having PSA tests twice a year since then.

Should this new recommendation simply serve as the start of a conversation between doctor and patient, leaving the decision for action -- if any -- up to them? Or should Medicare and private insurance companies just stop reimbursing for the test?

I'm similarly unsure what to think about other tests and procedures now being challenged. Do they help? Do they save lives? Do they cause harm? Do they add unbearable cost to our health care system? Do we check "all of the above"?

"No! The One Word That Can Save Your Life"
That was the title of a recent Newsweek cover story by respected science reporter Sharon Begley, who recapped the growing evidence that intervention and treatment are not always beneficial.

I was particularly interested in this comment by Dr. Michael Lauer, a cardiologist with the National Heart, Lung, and Blood Institute: "Our imaging and diagnostic tests are so good, we can see things we couldn't see before.... But our ability to understand what we're seeing to know if we should intervene hasn't kept up."

Magnetic resonance imaging (MRI) tests were cited as an example -- and one I can identify with. When I was taken to George Washington University Hospital after my car crash, I was given an MRI (about $3000). Based on some shadows on the MRI, my doctor diagnosed a possible neck injury. She gave me a neck brace to wear, took additional X-rays a week later (which provided no additional information), and advised a week after that to continue wearing the brace. By that time, I had jettisoned the neck brace on my own, since the pain I was experiencing was in my back, not my neck. I knew more about my own situation than that darned MRI, or the doctor who wanted to believe in its mysterious shadows!

Soon after, a back doctor diagnosed a compressed fracture in my lower back, a finding that was reconfirmed after a bone scan and pelvic CT (ordered after a scary jump in my PSA number). He ordered me to wear a back brace -- which is helping. If I'd not objected and sought additional opinions, I'd still be wearing that useless neck brace, based on George Washington Hospital's misinterpretation of an MRI. I shudder to think what additional harm that faulty MRI-inspired diagnosis might have caused me.

That Newsweek cover story makes these recommendations:

For Women
Recommended if you are over 50 or have an elevated risk of breast cancer. (But the article also notes that Dr. Rita Redberg, professor of medicine at the University of California, has no intention of getting a mammogram, even though she's over 50. She says the tests yield too many false positives and show tumors that might regress on their own. She believes there's little evidence that the tests save lives.)

Osteoporosis Screening
Recommended only if you're over 65 and show symptoms of bone loss.

Pap Tests
Recommended every three years, or more often if you have an abnormal result. Unnecessary if you've had a total hysterectomy or are over 65.

For Men
PSA Test
The article uses the old recommendation that the test isn't recommended if you're over 75. But the new proposed task force recommendation (see yesterday's post) suggests the test not be routinely used at all.

For Both Men and Women
Proton Pump Inhibitors
Use if a doctor prescribes them for gastric reflux. For ordinary stomach aches, risks exceed benefits.

Recommended only if you have diagnosed heart disease or are at high risk of a stroke or heart attack.

Blood Panel
Not recommended if you're healthy and just having a routine physical. Instead have only a specific blood component assessed, such as calcium if your doctor suspects a parathyroid tumor.

Recommended if you've had a heart attack less than 24 hours ago, but not if you are stable and have no more than mild chest pain.

Screening Colonoscopy
Recommended if your last test was abnormal, or you're at high risk of colon cancer, but not if you're over 75 or you've had a normal result within the past 10 years.

Do I challenge my doctor if he orders tests or procedures that are contrary to these recommendations?

How can our country reduce the unconscionable cost of tests and procedures that aren't needed  or
may even lead to harm? Do we want Medicare and private insurance companies to deny reimbursement?

I've got some thoughts. Tune in tomorrow.


John Martin said...

Prior to a diagnostic test, it's
always a good practice to ask your physician "What will this test tell us,
and if the test turns out to reveal some problem, what actions will be
available to us at that time?" Doctors are always wanting to do an MRI of
my shoulder until i explain that I won't be getting shoulder surgery under any
circumstances and then ask if there would be any other value to the information
on the MRI... The most important point here, I think, is that we need to be
informed consumers of medical care as we are of other products we purchase.
"Caveat emptor" applies to going to the doctor, as well.

John said...

John -Thanks.  Wise words, as always.  BTW, be interested in your thoughts on tomorrow's post. - John