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Doing Less Is More Sometimes
(Medical Tests)

By Dr. Peter W. Kujtan, B.Sc., M.D., Ph.D.

Article printed on page 29 in the July 10, 2014 issue of
The Mississauga News under the feature: Health & Beauty, Medicine Matters.
Portrait of Dr. Peter W. Kujtan, supplied 2005
Dr. Peter W. Kujtan

There is a new campaign in the Canadian medical landscape aimed at getting patients to make wiser choices regarding medical testing. The truth of the matter is that we doctors, often at the misguided request of our patients, order too many tests that have little scientific merit and waste truckloads of precious health care dollars. Check out a YouTube clip called "Choosing Wisely or visit www.choosingwiselycanada.org.

There are many examples where the science doesn't support the practice. Chest X-rays are a good start. There is no reason to do one on a healthy person without symptoms, even if they smoke. They rarely show something missed by a skilful clinician with a good stethoscope. Ankle x-rays for tissue pain are another example. They should only be used to look for the rare bone fracture. They cannot find a sprain, and the treatment is usually determined by the clinical examination. Repeating bone scans for osteoporosis in normal people on a yearly basis is completely without merit. The science tends to support an interval of closer to 10 years. New back sprains rarely need an MRI or CAT scan, but are the first thing patients ask for. All these tests come with a radiation exposure price. But some are totally justified and supported by science such as mammograms on women over 50 years of age and every two years.

Physical examinations have been reorganized to a three-year cycle. Part of the reason was "executive physicals". These were very high priced examinations paid for by third parties who made a huge array of unnecessary tests seem necessary for the privileged. These included ultrasounds, heart tests, food sensitivity tests and x-rays. Many of these patients would be given the "not so good" news in an envelope and then sent back to the OHIP system to get it all sorted out at large follow up costs.

Talking to a patient about improving their life-style takes a great deal of time and effort. Ordering a test, takes a minute. Sometimes, the test is just the thing to get the message across, and the balance between the two is truly part of the art of medicine. Other times, the anxiety around the tests is unbearable for patients. For example, some people obsess about blood pressure. They don't understand that blood pressure fluctuates with activity and feel very distressed if one reading is a little high. They will do almost anything to control that pressure except to lose weight, exercise and eat healthy. Seniors frequently request cholesterol checks, sometimes every few months. It seems like a lottery to me at times. If they get the right number, somehow it makes all the bad food they have been eating seem okay?

My grandmother advocated a simple and inexpensive test. She would suggest taking a good long look in the mirror before taking a lot of time and effort to prove it isn't so. Have a frank discussion with you doctor about which tests are necessary and make the choice together.

Related resources:

Choosing Wisely. YouTube video, 4:26 min. Posted by James McCormack. A parody of the infectious Pharrell Williams song.

Choosing Wisely Canada - Dr. Wendy Levinson, CWC - Wave 1 Launch. YouTube video, 3:16 min. Published on Jun 23, 2014.

Choosing Wisely from Wikipedia.

Choosing Wisely® is an initiative of the American Board of Internal Medicine (ABIM) Foundation. Choosing Wisely® aims to promote conversations between providers and patients by helping patients choose care that is: 1. Supported by evidence. 2. Not duplicative of other tests or procedures already received. 3. Free from harm. 4. Truly necessary.

Choosing Wisely Canada is a campaign to help physicians and patients engage in conversations about unnecessary tests, treatments and procedures.

Unnecessary medical tests need a rethink. A 'think twice' attitude recommended to avoid unnecessary and potentially harmful tests, treatments. CBC News Posted: Feb 18, 2014.

Doctors to cut down on "unnecessary" tests by Theresa Boyle, Toronto Star Health, Published: Feb 19, 2014. "Dr. Wendy Levinson is spearheading a national 'Choosing Wisely' campaign aimed at rooting out 'unnecessary' tests and treatments, some of which she warned may do more harm than good.

'For many years, both physicians and patients have had a 'more is better' attitude. It is time to adopt a 'think twice' attitude and to avoid unnecessary and potentially harmful tests, procedures and treatment,' she wrote in a commentary in the Canadian Medical Association Journal, published Tuesday [Feb. 18, 2014]."

Putting Tests to the Test: Many Medical Procedures Prove Unnecessary - and Risky. The overuse of many medical tests and interventions wastes money and can actually harm patients, say over two dozen medical societies. By Tara Haelle, Scientific American, Mar. 5, 2013.

Unnecessary Medical Tests from Huffington Post.

Unnecessary Screenings: 4 Medical Tests You May Not Need by Jessica Girdwain, Huffington Post, Posted: June 27, 2013. "According to a report in the Archives of Internal Medicine, 28 percent of primary care physicians admit to overtreating patients, including by ordering potentially unwarranted tests as a precaution against malpractice suits. Unfortunately, excessive screening can open the door to unnecessary surgeries and medications - not to mention needless anxiety."

Doctors Call Out 90 More Unnecessary Medical Tests, Procedures by Bruce Japsen, Forbes Pharma and Health Care. Posted Feb. 23, 2013.

How Medical Ripoffs Threaten Your Health and Financial Security by Dr. Mercola, Mar. 6, 2013.

Materials Educate Patients to Make Wise Choices on Tests and Procedures by Bridget M. Kuehn, Journal of the American Medical Association (JAMA). 2012;307(21):2245-2246.

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