UNNECESSARY TESTS
1. Imaging for low-back pain. Pain in the lower back
is the fifth-most-common reason for doctor visits. Doctors routinely
order MRIs of the lumbar spine when patients complain about back pain.
The problem: In the vast majority of cases,
imaging tests are unnecessary. Low-back pain typically clears up
without treatment in six weeks or less.
Exceptions: MRIs or other imaging tests may
be needed for severe low-back pain or pain that lasts longer than six
weeks...or when the symptoms include fever, incontinence, numbness and
tingling.
2. Blood tests/urinalysis. When you
have an annual exam, your doctor might order urine and/or blood tests. A
urine test typically is used to check for diabetes. Blood chemistry
panels are used to screen for diseases of the kidneys, liver and
parathyroid gland, among many other things.
The problem: These tests rarely reveal
anything in patients without symptoms who generally are healthy—and they
often lead to false-positives.
Exceptions: Patients with specific
symptoms—such as a persistent fever or tenderness in the
abdomen—probably will need to have blood tests to determine the cause. A
blood test also is recommended for checking cholesterol levels.
Urinalysis can be used to identify diabetes in patients who already
have symptoms, such as frequent urination and/or increased thirst.
There may be other good reasons your doctor wants to order blood
and/or urine tests, but he should be willing to explain to you exactly
what those reasons are.
3. Cardiovascular screening. You
don’t need an annual electrocardiogram (EKG) if you don’t have symptoms
of, or risk factors for, heart disease (such as smoking, diabetes or a
family history of cardiovascular disease).
The problem: Many doctors advise patients
to have an EKG every year. My doctor used to recommend it for me, but in
patients without symptoms, an EKG rarely reveals useful information. It
may show a minor abnormality in the heartbeat that will lead to further
tests, such as an echocardiogram or a stress test, even though these
abnormalities rarely are important.
Exceptions: Patients who have been
diagnosed with heart disease or who have significant risk factors for it
probably will need an annual EKG or other cardiac tests.
4. Bone-density scan. More than 28 million Americans
have osteoporosis, the leading cause of weak bones and fractures. A
test called dual energy X-ray absorptiometry (DEXA) can detect bone
weakness before a fracture occurs. This gives patients time to increase
bone strength with exercise and vitamin D/calcium supplements.
The problem: The test doesn’t make sense
for younger patients with a low risk for osteoporosis. If you’re a woman
under age 65, you routinely should be taking calcium and vitamin D
supplements and exercising to increase bone strength. The test itself
won’t change the treatment recommendations even if you test positive.
Exceptions: Women who are younger than 65
who have osteoporosis risk factors, such as smoking, a slight build,
hyperthyroidism or a history of bone fractures, should have this test.
So should men younger than age 70 with the same risk factors.
Women age 65 and older and men age 70 and older should have the DEXA
screening even if they don’t have risk factors. The DEXA test is
important for these groups of people because they have a high risk for
fractures and might benefit from medications.
UNNECESSARY TREATMENTS
5. Antibiotics for sinus infections.
Patients don’t realize that any upper-respiratory infection, including a
cold, will cause infection and inflammation throughout the area,
including in the sinuses. They often ask their doctors for antibiotics
to clear up postnasal drip, congestion or other sinus symptoms.
The problem: About 98% of sinus infections are
caused by viruses. Antibiotics do nothing for viral infections. Even
when a sinus infection is caused by bacteria, it usually will clear up
without antibiotics.
Exception: Antibiotics should be considered
for a sinus infection if the symptoms are severe, such as high fever
and severe pain and tenderness over the sinuses. Antibiotics also should
be considered when the symptoms last for one week, improve briefly and
then get worse—this may indicate that a bacterial infection has
developed on top of the initial viral infection.
6. Brand-name statins to lower cholesterol.
The statin class of medications is among the best ways to lower
cholesterol and reduce the risk for heart attack and stroke among people
who can’t achieve these goals with diet and exercise. All statins have
these benefits, including the generic versions.
The problem: Many doctors routinely prescribe
expensive brand-name statins, such as Crestor or Lipitor, rather than
the cheaper generics lovastatin, simvastatin or pravastatin. A generic
statin costs about $4 a month. A brand-name medication such as Lipitor
(atorvastatin), depending on the dose, costs about $150. However,
Lipitor lost patent protection last month, which means a cheaper generic
version will become available.
Between 75% and 80% of patients can achieve the recommended levels of
LDL cholesterol (below 130 mg/dL is typical) by taking generic statins.
Bottom Line/Personal interviewed Stephen R. Smith, MD, MPH,
professor emeritus of family medicine and former associate dean of The
Warren Alpert Medical School of Brown University in Providence. Based in
New London, Connecticut, he is on the executive committee and board of
directors of the National Physicians Alliance, a group of 22,000 members
that advocates for affordable, evidence-based health care. www.NPA
1. Imaging for low-back pain. Pain in the lower back
is the fifth-most-common reason for doctor visits. Doctors routinely
order MRIs of the lumbar spine when patients complain about back pain.
The problem: In the vast majority of cases,
imaging tests are unnecessary. Low-back pain typically clears up
without treatment in six weeks or less.
Exceptions: MRIs or other imaging tests may
be needed for severe low-back pain or pain that lasts longer than six
weeks...or when the symptoms include fever, incontinence, numbness and
tingling.
2. Blood tests/urinalysis. When you
have an annual exam, your doctor might order urine and/or blood tests. A
urine test typically is used to check for diabetes. Blood chemistry
panels are used to screen for diseases of the kidneys, liver and
parathyroid gland, among many other things.
The problem: These tests rarely reveal
anything in patients without symptoms who generally are healthy—and they
often lead to false-positives.
Exceptions: Patients with specific
symptoms—such as a persistent fever or tenderness in the
abdomen—probably will need to have blood tests to determine the cause. A
blood test also is recommended for checking cholesterol levels.
Urinalysis can be used to identify diabetes in patients who already
have symptoms, such as frequent urination and/or increased thirst.
There may be other good reasons your doctor wants to order blood
and/or urine tests, but he should be willing to explain to you exactly
what those reasons are.
3. Cardiovascular screening. You
don’t need an annual electrocardiogram (EKG) if you don’t have symptoms
of, or risk factors for, heart disease (such as smoking, diabetes or a
family history of cardiovascular disease).
The problem: Many doctors advise patients
to have an EKG every year. My doctor used to recommend it for me, but in
patients without symptoms, an EKG rarely reveals useful information. It
may show a minor abnormality in the heartbeat that will lead to further
tests, such as an echocardiogram or a stress test, even though these
abnormalities rarely are important.
Exceptions: Patients who have been
diagnosed with heart disease or who have significant risk factors for it
probably will need an annual EKG or other cardiac tests.
4. Bone-density scan. More than 28 million Americans
have osteoporosis, the leading cause of weak bones and fractures. A
test called dual energy X-ray absorptiometry (DEXA) can detect bone
weakness before a fracture occurs. This gives patients time to increase
bone strength with exercise and vitamin D/calcium supplements.
The problem: The test doesn’t make sense
for younger patients with a low risk for osteoporosis. If you’re a woman
under age 65, you routinely should be taking calcium and vitamin D
supplements and exercising to increase bone strength. The test itself
won’t change the treatment recommendations even if you test positive.
Exceptions: Women who are younger than 65
who have osteoporosis risk factors, such as smoking, a slight build,
hyperthyroidism or a history of bone fractures, should have this test.
So should men younger than age 70 with the same risk factors.
Women age 65 and older and men age 70 and older should have the DEXA
screening even if they don’t have risk factors. The DEXA test is
important for these groups of people because they have a high risk for
fractures and might benefit from medications.
UNNECESSARY TREATMENTS
5. Antibiotics for sinus infections.
Patients don’t realize that any upper-respiratory infection, including a
cold, will cause infection and inflammation throughout the area,
including in the sinuses. They often ask their doctors for antibiotics
to clear up postnasal drip, congestion or other sinus symptoms.
The problem: About 98% of sinus infections are
caused by viruses. Antibiotics do nothing for viral infections. Even
when a sinus infection is caused by bacteria, it usually will clear up
without antibiotics.
Exception: Antibiotics should be considered
for a sinus infection if the symptoms are severe, such as high fever
and severe pain and tenderness over the sinuses. Antibiotics also should
be considered when the symptoms last for one week, improve briefly and
then get worse—this may indicate that a bacterial infection has
developed on top of the initial viral infection.
6. Brand-name statins to lower cholesterol.
The statin class of medications is among the best ways to lower
cholesterol and reduce the risk for heart attack and stroke among people
who can’t achieve these goals with diet and exercise. All statins have
these benefits, including the generic versions.
The problem: Many doctors routinely prescribe
expensive brand-name statins, such as Crestor or Lipitor, rather than
the cheaper generics lovastatin, simvastatin or pravastatin. A generic
statin costs about $4 a month. A brand-name medication such as Lipitor
(atorvastatin), depending on the dose, costs about $150. However,
Lipitor lost patent protection last month, which means a cheaper generic
version will become available.
Between 75% and 80% of patients can achieve the recommended levels of
LDL cholesterol (below 130 mg/dL is typical) by taking generic statins.
Bottom Line/Personal interviewed Stephen R. Smith, MD, MPH,
professor emeritus of family medicine and former associate dean of The
Warren Alpert Medical School of Brown University in Providence. Based in
New London, Connecticut, he is on the executive committee and board of
directors of the National Physicians Alliance, a group of 22,000 members
that advocates for affordable, evidence-based health care. www.NPA
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