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Title

Unnecessary tests

Created date

July 24th, 2012
Matt Narrett, M.D., is chief medical officer for Erickson Living and directs the provision of medical care at all Erickson Living communities. He received his medical degree from Harvard Medical School and is board certified in internal medicine and geriatrics. He is coauthor of Old Is the New Young, a guide to successful aging (available on amazon.com). We live in a truly exciting era of medical care with breakthroughs and advances improving the quality of our lives every day. It is now possible to detect medical problems earlier than ever before and prevent progression of illness and disease. While this is indeed a wonderful opportunity for us all, it also creates a certain amount of risk the risk of doing too many tests, which in some cases may not be necessary and potentially can do more harm than good. In light of these safety concerns, the American Board of Internal Medicine Foundation developed the Choosing Wisely campaign aimed at improving health care quality and avoiding unnecessary tests. The Foundation s recommendations are based on scientific evidence obtained over many years, and recently they ve identified overused medical tests that both physicians and patients should be aware of as they make health care decisions.

Tests in question

A good example is the PSA blood test in men over the age of 75. PSA stands for prostate specific antigen, and it has been widely used for screening for prostate cancer in men. This has led to early detection of prostate cancers that might otherwise have never been discovered. While this sounds like a successful result, in reality, many of these tumors in older men will never progress or become symptomatic therefore, treatment may not result in longer life or better quality of life. In addition, all the procedures, treatments, and complications that may occur because of an elevated PSA may not be necessary and could have been avoided simply by not ordering the test in the first place. Other tests that have been identified as requiring greater discussion between provider and patient include imaging tests such as MRIs or CT scans for nonspecific back pain; screening exercise stress tests for healthy individuals at low risk for heart disease; and performing routine chest x-rays on all patients before surgery. While all of these tests can be entirely appropriate in many circumstances, it is always important to review with your doctor the pros and cons of undergoing any procedure, whether a simple blood test or a more complex imaging exam. Make sure you discuss your goals and that you fully understand the implications of a positive result and what might come next in further evaluation. It certainly is the very best of times in medical care. Please take the time to be informed and make the decision that makes the most sense for you. In good health, Dr. Narrett

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