The medical establishment has become a major threat to health. Ivan Illich. Medical Nemesis
Laboratory tests and scan results form the scientific basis of present-day medical practice, because they provide a valuable window into what’s wrong with the patient. Modern medicine is therefore largely dependent on these tests as they help doctors to come to an accurate diagnosis.
While it is true that lab tests can be very useful, they are often misused as well. With billions of medical tests being performed every year, modern physicians appear to be relying more on tests results rather than on their clinical skills to make a diagnosis. And testing often means big bucks for doctors because of the kickbacks diagnostic centers offer them to refer patients.
The “defensive medicine” trend
Many doctors have also started practicing “defensive medicine” in order to protect themselves in case they are sued by unhappy patients or their relatives for negligence. After all, few lawyers will find fault with a doctor who performed too many tests, but woe betide the doctor who fails to perform a test, if his patient falls victim to an unfavorable outcome! However, testing can actually be harmful. Not only is it a financial drain, but it can also lead to a domino effect of spiraling testing, if the initial results are abnormal! And the more the medical interventions you are subjected to, the greater the risk for medical errors.
Remember that if your doctor performs enough tests on you, the mathematical certainty is that he will find something wrong with you. And if he finds something wrong with you, he’ll usually end up treating you-whether you need treatment or not! However, such diagnostic labeling may be harmful to you, because the ‘diagnosis’ has now transformed you from a person into a ‘patient’, even though the abnormality may be a ‘red herring’ which has no significance to your medical problem!
Many cynics call these abnormalities ‘incidentalomas’ (for example, a small fibroid in the uterus detected on an ultrasound scan), and these often result in unnecessary surgery as well, which exposes you to the risk of harm. Don’t forget that tests are not always benign. Invasive tests, that is, those that entail introducing instruments (such as endoscopes) or chemicals (such as radio-opaque dyes) into the body, generally, involve some risk of harm, which may include infection, allergic reaction, or injury to an internal organ.
Sometimes, a test may lead to complications which are more dangerous than the benefit to be derived from the test results. While this is usually not the case, you need to consider the risk-benefit ratio of all tests, especially expensive and invasive ones!
All tests have their limitations that patients need to understand. In other words, merely conducting more tests does not ensure better medical care; after all, the value of a test to the patient depends not only on the skill in interpreting its result, but also on the clinical judgment exercised in ordering the test in the first place. For example, when we carry out a semen analysis (sperm test) to check a man’s fertility, the question to which we seek an answer is: are these sperm capable of ‘working’ or not, i.e., can they fertilize an egg?
Unfortunately, present-day tests simply cannot answer that question! A semen analysis simply provides an accurate count of the total number of sperm and their ability to swim, but because there is such a wide range of normality, the results cannot be used to predict a man’s fertility. Similarly, a positive skin test for TB (the Mantoux test) simply means that the patient has been exposed to the tubercle bacillus in the past (as most of us in India have been!) Such a result does not mean that the patient is suffering from an active TB infection, an erroneous conclusion many patients (and their doctors) still jump to.
How can you protect yourself from over-testing?
In the final analysis, remember that medical tests can be helpful in pinpointing your problem, but they need to be used wisely and well; after all, doctors do not treat abnormal test results, they treat patients. When a test is recommended, the single most important question you must ask is-How will the result of the test change the course of your treatment? And if the answer is that it really won’t, then maybe you don’t need the test at all!
Here is a checklist of the important factors you need to consider before going in for a medical test.
The hazardsThe hazards of over-testing often go hand in hand with the risks of its first cousin, overtreatment. The media regularly carry reports extolling the virtues of the newest technologic tools in medicine. How is a patient to make sense of which technology may be useful for his particular illness? New technology can be dazzling, and undoubtedly, when medical technology is used properly, it can save many lives. However, every rose has its thorns and technology can be a two-edged sword.
For example, the introduction of antibiotics was very quickly followed by their misuse, leading to rampant antibiotic resistance amongst bacteria and an ever-increasing rate of hospital-acquired infections. We need to remember that new does not always mean better, and that time-tested medical procedures are often better than the latest gadget on the market! Sadly, many new medical treatments gain popularity over older standards of care due to clever marketing, rather than any solid science.
Most patients with complex chronic illnesses have a small army of very highly specialized doctors, each of whom treats the abnormal lab results in his own medical domain, while ignoring what the other specialists are doing, and not paying any attention to the patient at all!
None of the doctors has a 360 degree overview of the treatment the patient is getting. The result can be dangerous medical chaos because modern medicine consistently violates the ancient advice of Hippocrates: “It is better to know the patient who has the disease than the disease the patient has.”
Doctors love looking at medical images and doing procedures. They get paid a lot for doing these, which is why they continue doing more of them! In a more rational world, doctors would care about risks and harms, and wouldn’t always be rushing to order pointless dangerous tests and treatments. Too many doctors, too many tests, and too many procedures, with no one keeping track is a recipe for disaster, and the disasters continue to happen. You can protect yourself by visiting the Choosing Wisely web site at http://www.choosingwisely.org. It provides information on a wide varie
Unnecessary screening testsTo add insult to injury, doctors are no longer waiting for patients to fall ill. They are now converting well persons into patients, by “screening” them for illnesses. While this seems like a great idea in theory, because prevention is better than cure, this “testitis” means that even more unnecessary tests are being done on a much larger scale, and lots of blissfully unaware people are being sucked into getting medical care they do not really need.
Unfortunately, due to the widespread fallacy that the human body is no better than a machine, we have been taught that the body needs ‘routine maintenance’ which should be performed by a doctor, much as your mechanic tunes up your car periodically. Many people effusively gush: ‘Doctor, give me the works, I want a full check-up!’ Many clinics now readily pander to this demand by providing a wide range of ‘executive health check-up schemes,’ but often these ‘schemes’ can be more harmful than beneficial !
In fact, routine tests, such as electrocardiograms, chest X-rays and full blood screening, have been found to provide little overall benefit for the healthy individual. The reason these health check-up schemes have become so popular is because they bring in the ‘moolah’! After all, much more money can be raked in by screening droves of healthy people, rather than by only taking care of sick patients. And then there is the additional lucrative bonus that the screening tests will ‘pick up’ abnormalities,thus converting a formerly healthy person into a patient who needs medical attention!
In fact, the only routine tests that the US Preventive Services Task Force recommends are those for blood pressure, cholesterol, colorectal cancer, breast cancer and cervical cancer. This task force refused to recommend widespread screening for other diseases for two reasons: either the tests had been found to have no merit, or there wasn’t enough evidence to prove their benefit (i.e., they did not help to improve either life expectancy or the quality of life). In fact, screening tests could have a major negative impact on one’s health, which is why they should be undertaken with a great deal of discretion and caution!
To see how much harm these apparently benign screening tests can do, let’s look at the highly publicized controversy over the need to screen men for prostate cancer, by ordering a blood test for determining the presence of PSA (prostate-specific antigen). The PSA test measures the level of a specific protein in the blood that can indicate cancer and other prostate abnormalities. The drawback with this test, as with most screening tests, is that an elevated level of PSA is not diagnostic of prostate cancer.
In fact, a number of patients who are completely normal are found to have elevated PSA levels. Then, in order to prove that they are not suffering from prostate cancer, they will be subjected to a prostate biopsy, and sometimes even surgery to remove the prostate altogether. The adverse consequences of widespread screening include:
* A large number of false positive results, causing needless anxiety and concern
* Unnecessary biopsies
* Harmful effects of aggressive treatments for slow growing cancers that may never have caused symptoms in a patient’s lifetime and could have been left well alone.
When less is moreModern medicine has finally realized that simple common sense measures to improve your lifestyle are much more effective than undergoing complex and exorbitant tests and scans for remaining healthy. The trouble is that these measures are greatly undervalued by patients due to their simplicity! It is futile to squander money on unnecessary tests during your check-ups.
Remember that using your common sense is more important than getting a 20-page glossy computerized health checkup report. The reason for the current epidemic of avoidable care is that free-market medicine treats health care just like any other business commodity, and ends up putting profits before patients. For now, your only protection is being a well-informed consumer.