Know what the most expensive thing is in health care? A faculty doctor tested Dr. John Schumann, a general internist and medical educator, when he was training to become a doctor.
Of a million possible answers, 'a doctor's pen,' was what the teaching physician was looking for.
In CT This, Dr. Schumann asks, 'How and when do new medical technologies become the 'standard of care'?' He recalls that physicians used to be more deliberate and careful about ordering CT scans because they were expensive and inconvenient. Now they are used for everything from headaches to abdominal pain because doctors fear they will miss something and patients want them, Dr. Schumann says. He wants patients to prompt their doctor to consider if they need a CT scan.
Gastroenterologist Dr. Michael Kirsch of MD Whistleblower would agree. He advocates that both 'physicians and patients should ask before a test is performed if the information is likely to change the medical management.' He reminds clinicians that tests should be performed to answer a specific question rather than used as a 'buckshot approach.'
In 'Another Test? No Thanks, Doc,' WSJ writer and cancer survivor Ellen Graham offers a patient perspective. She says, 'I regularly see six physicians, each of whom treats their discrete niche of my body as aggressively as they know how. All are competent and compassionate, but the net result of their combined attentions is to leave me feeling like a rusted-out car, ever in need of tune-ups, replacements parts and service appointments.' She struggles with balancing overaggressive care with more passive surveillance like 'watchful waiting.' She negotiates with her doctor: spreading out the length of time between visits, reducing the frequency of CT scans, and stopped taking two drugs that caused her muscle pain. She says the doctors have been supportive of her wanting her 'life back.
However, not all people desire less testing. ACPHospitalist highlights recent findings that 'emergency patients with acute abdominal pain feel more confident about medical diagnoses when a doctor has ordered a CT scan.' Although, patients underestimate the radiation risk that CT scans pose. The post also mentions the Archives of Internal Medicine 'Less is More' series, which examines the overuse of medical care that may result in harm to an individual.' Authors of the series recommend that 'there are safer ways to reassure patients' and 'talking with our patients should be our first choice for reassurance; tests should be reserved for cases in which the benefits can be reasonably expected to outweigh the risks.
Anna Sayburn of BMJ Group was offered a free preventative CT scan a few years ago. She discusses her satisfaction with her decision to say 'no' to the 'opportunity' after recent research shows the risks of CT scans. She writes Is That CT Scan Worth the Risk? on Consumer Reports Health Blog.
Dr. John Schumann M.D., general internist and medical educator at University of Chicago, blogs on GlassHospital. Ellen Graham is a writer in Virginia, and her essay is featured in The Wall Street Journal. ACPHospitalist is a blog from the American College of Physicians that provides news and information for internists about the practice of medicine. Dr. Michael Kirsch blogs on MD Whistleblower, and Consumer Reports Heatlh.org features the Health Blog with the latest news, research, and expert advice on health topics.