Our media often report medical malpractice and how doctors miss diagnoses that change the patients’ lives to boost viewership. It encourages patients to sue physicians, which leads to defensive medicine in the West. As physicians, we are taught the human pathophysiology of diseases, but we are also trained always to cover our butts. I still remember observing defensive medicine in my clinical rotations. My preceptors always ordered extra tests to be cautious. For example, there is clearly no utility in measuring heart attack enzymes in the setting of pneumonia, but many providers will still get a complete set of blood work, EKG, and maybe even a stress test. Some may even order a CT scan for muscle strain with no clear indication. However, the media often don’t talk about the downside of excessive testing. Here are a few reasons you should not ask to get more tests at your next clinic visit.
1. It can cause harm to your health.
Believe it or not, you can be harmed when you ask for excessive testing that is not necessary. The evidence behind modern medicine has not caught up with the explosion of our medical technology. We are given so much information about the tests we order in medical practice. We have a lot of incidental findings of an abnormal blood test, anatomy, and information. We find tumors incidentally on CT scans (not necessarily bad). We also find abnormal EKGs that may not mean anything. But whenever I counsel patients, they always demand further testing and investigations because the computer lists these findings are “abnormal”. I often explain to my patients that they are most likely normal variants. There are many tests that we do not recommend routinely performed because they can cause harm to our patients. We don’t order routine CT scan to look and screen for cancer. It has a high amount of radiation, and it is often not sensitive enough to catch any form of cancer. We also don’t order testing for prostate cancer and routinely perform rectal exams because it lacks evidence of their efficacy in screening for cancer. But most importantly, you can find these “abnormal” things on your tests and end up receiving a procedure that you may not even be needed in the first place. And every procedure has its risks and benefits; some people even die from the most straightforward procedure.
2. They are expensive.
Secondly, excessive testing is expensive. Our healthcare in the United States cost 4.1 trillion dollars in 2020, and about 12,000 dollars per person annually. An average CT scan costs about 1200 dollars, and an MRI can cause up to 2000 dollars. These do not include the physicians trained to read those scans and the technicians trained to perform these scans. Unfortunately, despite significant effort from the senior doctors to educate the next generation of physicians about over-ordering tests, it is natural for us to “not want to miss anything”. It is common to have a hospital bill that can cost hundreds of thousands of dollars. You can quickly go broke trying to pay these bills as we do not have universal healthcare in the United States. Instead, doing less is more. Rather than asking for extra tests, you should focus on a healthy lifestyle with physical fitness and eat healthy food. Focus on foods that contain many antioxidants, vitamins, and essential minerals. Do what you can to avoid sedentary lifestyle, this has been shown to reduce the incidence of heart diseases, cancer, and improve longevity.
3. It is not evidence-based.
Last but not least, ordering extra testing is not evidence-based. In medical school, we learn about the importance of evidence-based medicine. We want to do what is right for the patient without causing harm. For the most part, we follow what has been shown to be helpful, and what has not in the practice of medicine. We have clinical guidelines and randomized control trials to help us decide what we should be doing. Unfortunately, physicians are also human, and we do get reimbursed for what we order. Some doctors unethically order extra test to make sure everything is “okay”. I urge you, as a patient, to ask your doctor why they are ordering a specific test. For example, you had a pneumonia last week and was treated with antibiotics. Ask them why they are repeating another CXR, it has clearly no benefit if your symptoms has significantly improved except for exposing yourself with radiation. If you had a heart attack last week and everything is fixed with a stent, and you had no more chest pain, why are we getting another angiogram and procedure to look for more blockages? Patient like you need to ask the doctor why they are doing more than they should. In the end, physicians and patients should work as a team. The decision on testing and treatment should be communicated thoroughly, so both parties know exactly what is going on. In that way, we can minimize our healthcare costs and improve our patient outcomes from unnecessary testing.
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