Less is More… When it comes to Some Healthcare Services — June 2013


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In February, doctors from 25 medical specialty societies called into question 130 commonly ordered but often unnecessary tests and procedures. “Millions of Americans are increasingly realizing that when it comes to health care, more is not necessarily better,” said Dr. Christine Cassel, president of the American Board of Internal Medicine (ABIM) Foundation.

Last year, the ABIM Foundation and Consumer Reports launched the Choosing Wisely Campaign, which seeks to reduce the tendency to over-test and over-treat, especially in light of the risks and serious side effects such interventions can involve. Dr. Cassel hopes guidelines released by the ABIM Foundation will “encourage conversations between physicians and patients about what care they truly need.” The guidelines address areas such as:

  • Allergy tests: When you need them and when you don’t.
  • Antibiotics: When children need them for respiratory illness and ear infection.
  • Bone-density tests: When you need them.
  • Why scheduling early delivery of your baby isn’t a good idea.
  • EKGs and exercise stress tests: When you need them.
  • Imaging tests for lower-back pain: When you need them.

Research shows that over-testing and over-treating can expose people to unnecessary health risks. Take radiation from imaging like CT scans. The American College of Radiology is concerned about the risk of cancers related to medical radiation, estimated at up to 29,000 cancers each year. According to the American Nuclear Society, the average dose of radiation a year per person is 620 millirems (mrem). For perspective, exposure from a chest x-ray is 10 mrem and a chest CT scan is 700 mrem*.

A Tricky Case in Point

Another example is the PSA test. In 2012, the U.S. Preventive Services Task Force recommended that doctors stop using the PSA test to screen healthy men over 50 for prostate cancer. The PSA test measures blood levels of a protein produced by the prostate gland. In general, the higher a man’s PSA level, the more likely he has prostate cancer. However, the PSA test can give false-positive or false-negative results. A false-positive test—when PSA levels are elevated but no cancer is present—can lead to additional procedures, like a prostate biopsy, which carries the risk of serious infection, pain and bleeding. It can also cause anxiety for the man and his family. A false-negative result—a low PSA level even though cancer is present—gives false assurance that a man is cancer-free when he is not.

It is important to note that there are other reasons, such as prostatitis or urinary tract infection, for having an elevated PSA level. Levels can rise after prostate biopsies and surgery. Also, some drugs, like those used to treat benign prostatic hyperplasia, lower PSA levels. Given the possibility of false-positive and false-negative results and being subjected to a potentially unnecessary battery of other tests and procedures, deciding to have a PSA test should be carefully considered with your healthcare provider, keeping the needs of your situation in clear focus.

Your provider may recommend the PSA test when prostate cancer is suspected, in combination with a digital rectal exam (DRE), and/or to track change in levels over time.

It’s About Time

Besides being subjected to unnecessary risks, there is the issue of lost time. It takes time and energy to attend appointments for these services, and time is a precious commodity for busy, working people. It’s also a good idea to find out in advance if services are covered by insurance so you don’t end up with an unexpected out-of-pocket expense.

How You Can Help

Sometimes patients request tests that are not indicated for their medical condition. Rather than insisting upon a test or procedure, ask questions, explore the pros and cons, and evaluate how having the results of the service will affect your next actions. If after thoughtful study, you decide to proceed with testing, you can feel confidant that you played an active role in choosing your healthcare services.

KnovaSolutions is available to assist as you take that active role. Your nurse can provide information about the risks and benefits of the services you’re considering and talk with you about your options. We are available at 800/355-0885, Monday-Friday, 8 am-5 pm, MT.

 

To See the Full List of Resources from Medical Specialty Societies and Consumer Reports, click here.

 

The information contained in this newsletter is for general, educational purposes. It should not be considered a replacement for consultation with your healthcare provider. If you have concerns about your health, please contact your healthcare provider.

 

Click here to to view/download the full newsletter.

 

Have a comment or question? Respond below and a KnovaSolutions nurse or pharmacist will reply.

 


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2 Responses to Less is More… When it comes to Some Healthcare Services — June 2013

  1. I’m surprised this article didn’t mention mammograms. There is mounting evidence that not only do they over-diagnose, but the radiation can cause damage itself.

    • Hi Colleen,

      Thanks for your comment. Mammograms are indeed among those tests that many women and health professionals question, though they were not among the 5 tests and procedures that the American College of Obstetrician and Gynecologists (ACOG) or the American College of Radiology submitted to the Choosing Wisely Campaign. (The 25 medical societies that are members of the Campaign were limited to just 5 tests/procedures around which they provided parameters of use, even though there might be other important ones of note.) While ACOG recommends annual mammogram screening beginning at age 40, deciding when to have the first mammogram and how often thereafter is a personal decision to make with your provider depending upon your age, lifestyle, and family history. But you are correct, there are risks associated with mammograms; results can lead to additional–and sometimes unnecessary–testing, biopsies, and radiation exposure. Thanks for raising the topic, we wish we could cover more detail in our short newsletter! Please let us know if there are other topics you are interested in for future newsletters.

      Best,
      Shawn Petrini, RN, MSN

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