5 Medical Tests and Procedures That You May Not Really Need
There’s good news all around in the medical world, thanks to an effort to reduce medically unnecessary tests and procedures. “Turn your head and cough,” might be something men will now hear less frequently from your doctor, and Granny might not need regular pap smears anymore.
The goal of this effort is to reduce unnecessary and duplicate care, as well as procedures and medications that probably do more harm than good, without cutting back on truly necessary care. Choose Wisely, a project of the ABIM Foundation, has asked societies of physicians from many specialties to each create a list called “Five Things Physicians and Patients Should Question.” To date, more than 50 specialty societies have done so, and more plan to in the near future.
The lists they compiled follow several wise guiding principles: Don’t take action when the problem will most likely get better on its own. Don’t prescribe a drug that won’t work anyway. Don’t keep testing low risk patients for problems when the tests are not proven to improve patient outcomes and may instead cause false positives, unnecessary procedures, and increased patient anxiety.
Here are several changes you may notice when you visit your doctor:
1. Prostate Exams
Most likely, you’re familiar with the tests and procedures that doctors consider routine – or at least, used to consider routine. Regular prostate screenings may soon be no more. The American Academy of Family Physicians states that, “There is convincing evidence that PSA-based screening leads to substantial over-diagnosis of prostate tumors. Many tumors will not harm patients, while the risks of treatment are significant. Physicians should not offer or order PSA screening unless they are prepared to engage in shared decision making that enables an informed choice by patients.”
2. Pap Smears
That’s the good news for the boys. And now some for the girls. Get ready to have a lot fewer Pap smears. Whereas it was once the norm to screen women annually from age 18, now screenings begin at age 21. Women under 30, says American Academy of Family Physicians, should only be screened for HPV (Human Papillomavirus) and not for cervical cancer, and pelvic exams should no longer be required prerequisites for birth control pill prescriptions. Women over 65 who are at a low risk of cervical cancer and women who have had hysterectomies for non-cancer reasons are off the hook entirely.
And, adds the American College of Obstetricians and Gynecologists, women over 30 only need Pap smears once every three years. Additionally, when your Pap smear comes back abnormal, in cases where the problem typically clears up on its own, they recommend your doctor wait to see if it does before prescribing treatment.
3. Smarter Use of Antibiotics
You might even see items on the list that recommend against care you’ve previously received. When I was a kid, I took antibiotics for every single ear infection I got. The American Academy of Family Physicians now recommends doctors observe the infection for 48 to 72 hours (while treating symptoms) before going ahead with a possibly needless course of antibiotics.
As I grew a bit older, I began taking antibiotics for every sinus infection. Nowadays, most of those drugs would be seen as unnecessary. The American Academy of Pediatrics recommends holding off on the antibiotics for viral respiratory infections (bronchitis, sinusitis, and pharyngitis). The American Academy of Family Physicians concurs about the sinus drugs, noting that, “Most sinusitis in the ambulatory setting is due to a viral infection that will resolve on its own. Despite consistent recommendations to the contrary, antibiotics are prescribed in more than 80 percent of outpatient visits for acute sinusitis. Sinusitis accounts for 16 million office visits and $5.8 billion in annual health care costs.”
4. Migraine Care
There’s a fine line, however, between reducing needless, costly, stressful, and often unpleasant medical care and failing to provide patients with the care they actually need. The American Headache Society says that doctors should avoid ordering imaging studies for patients who obviously suffer from migraines. However, they note that doctors should only diagnose migraines after careful examination, because not all severe headaches are migraines.
In my own case, my “sinus headaches” turned out to be chronic migraines and my doctor did order a brain MRI to make sure they were only migraines, nothing worse. The MRI was normal, and a possible waste of money.
But when my grandmother complained of a “migraine” in 2008, it turned out to be a brain hemorrhage. She nearly died. The hemorrhage was ultimately revealed by an imaging study and a heroic doctor performed two emergency brain surgeries on her, thus saving her life. Maybe I didn’t need an MRI, but she did.
5. Labor Induction and Caesarian Sections
Another set of recommendations many families can relate to involve scheduled C-sections and inducing labor. According to the American College of Obstetricians and Gynecologists, physicians should not schedule elective labor inductions or Caesarian sections prior to 39 weeks in a pregnancy as it increases risk to the health and life of the baby. Between 39 and 41 weeks, they caution against scheduling elective, non-medically indicated labor inductions, “unless the cervix is deemed favorable.”
Physician and midwife Aviva Romm provides more explanation for this. “Too often,” she writes, inductions “are done unnecessarily, leading to a domino effect of additional interventions including intravenous medications, epidural pain relief, and even a cesarean section.” She lists off and explains several risks of induction, including preterm birth, infection, uterine rupture, and fetal distress, depending on the method of induction used.
Romm opposes all elective labor inductions, not just those prior to 39 weeks, but the American College of Obstetricians and Gynecologists only recommends against elective inductions from 39 to 41 weeks if the cervix is not yet ready for labor. If this is the case, a woman who is induced has an increased risk of having a C-section.
Getting the Word Out
In addition to disseminating these recommendations to physicians – many of whom are probably already familiar with them – Choose Wisely has teemed up with Consumer Reports to share them with patients as well. AARP has also published several articles sharing information from the Choose Wisely lists that are particularly relevant to the elderly.
To make use of these lists yourself, check the Choose Wisely website before a doctor’s appointment to find the list for the appropriate specialty or a relevant patient-friendly version, which is also offered on the same page. You can also download a PDF of all of the various lists combined.