Wednesday, September 14, 2011

Too Many Medical Tests

A story from Kaiser Health News and The Washington Post:
Concern Is Growing That The Elderly Get Too Many Medical Tests

...Is saying that more is not always better when it comes to medical tests," and that becomes particularly true in older Americans." A decade ago I would have disagreed. What's wrong with testing? Even if it results in a false positve, that will eventually be discovered and you're on your way, right? Testing isn't that invasive, besides, if it finds something wasn't the cost worth the benefit? I don't think that anymore.
"Too often these tests, some doctors and researchers say, trigger a cascade of expensive, anxiety-producing diagnostic procedures and invasive treatments for slow-growing diseases that may never cause problems, leaving patients worse off than if they had never been tested. In other cases, they say, treatment, rather than extending or improving life, actually reduces its quality in the final months."
The U.S. Preventive Services Task Force, an independent panel of experts that evaluates the risks and benefits of screening tests:
  • Does not endorse PSA testing after age 75.
  • Does not endorse colon screening after age 75.
  • Does not recommend a repeat colonoscopy within 10 years if the previous one was normal.
  • Says there is no evidence for or against mammography after age 74.
  • Recommends most women stop getting Pap smears to detect cervical cancer after 65.
What do you think? Should women in their 80s be getting mammograms? Should we be doing colonoscopies on people over 75, given that "colon polyps take 10 to 20 years to become cancerous, while the risks from colonoscopy, including intestinal perforation and heart attack, substantially increase after age 80?"


Anonymous said...

I am 76 and in excellent health. I just refused to schedule a colonoscopy because the one I had 5 years ago found nothing. I had a mammogram a couple of weeks ago (last one in 2007) negative - all my mammograms over the past 30+ years have been negative. My last pap exam was 4 years ago -negative - every one in the past has been negative.
I do not plan to have any of the above tests again unless some physical symptom appears. Given the longevity in my family - I could live another 15-25 years. I might develop something - but I will let the symptoms appear rather than submit to expensive screening exams.
We spend entirely too much money screening older people for diseases for which they have no symptoms. When symptoms appear - then look for the cause - and stop looking for needles in a haystack.

Dr. Mel said...

Not to keep beating the same drum, but too many medical tests (done b/c the patient, my Dad, had good federal Blue Cross insurance) killed him--my Dad, that is. And they kept him hospitalized for a month (guess what, he got C-diff). I kept trying to spring him outta there, but they kept saying "one more test." He died the day before he was scheduled for release. It broke his heart, literally, and it broke my emotionally. I have NO PATIENCE w/ most docs and most hospitals.

Bix said...

I thought about your father.

The thing is, of course older people are going to have things go wrong. But what is normal and what is a problem? I'm resistant to making any complaint lest it end up with lab work and x-rays. And I may just have pulled my shoulder!

There's a really great list of clinical practice errors I saw recently by the old editor of JAMA, Dr. Lundberg. I'll post it if I can find it. He addresses just this point.

Dr. Mel said...

Sorry to hear about your shoulder! Hope it feels better.

Bix said...

Aw, nice of you, Melinda. But my shoulders are okay. It was just an example.