Q: I read an article that said that at my age I should have several medical tests. But my doctor says some of them are unnecessary. What should I do?
A: As doctors, we like to order tests that will detect or prevent disease. Some of these tests are ordered out of habit or for medical legal fears, but often there is little evidence that they will benefit the patient.
Most importantly, some tests might detect clinically insignificant tumors or abnormalities that will give a patient a new insignificant “diagnosis.”
For example, a patient visits the hospital emergency room and a routine chest CT scan is performed, even though it is not related to the patient’s health concern.
If the scan finds a new thyroid nodule, a radiologist will be obligated to recommend further imaging. Most small thyroid nodules are benign and never turn into cancer, but now the patient will be subjected to further tests, resulting in increased care costs and unnecessary anxiety.
This is just one example of over-diagnosis.
During an annual physical, some routine tests might be ordered, although there is no specific clinical reason or preventive purpose. Three common tests that come to mind are the chest X-ray, electrocardiogram (EKG) and urinalysis.
A large study published in the Journal of the American Medical Association in 2011 found there is no benefit to annual routine chest X-ray screenings for lung cancer. Consequently, the National Cancer Institute now discourages these screenings.
EKGs, which are typically performed annually in many doctors’ offices, benefit no one without symptoms or other major cardiac diseases. Even in patients with stable chronic cardiac diseases, it is unlikely an EKG will provide new information.
In fact, the U.S. Preventive Services Task Force, the American Academy of Family Physicians and the American College of Cardiology recommend not screening low-risk, asymptomatic patients with an EKG.
Routine urinalysis is not advised in healthy individuals, due to the risk of false positives.
Chest X-rays, EKGs and urinalysis all run the risk of false positives, which result in further testing and concern for the patient.
There is a time and a place for medical testing, including the ones mentioned here. To avoid over-testing and over-diagnosis, talk to your doctor about any tests he or she orders for you. Ask why your doctor wants the test and what he or she hopes to learn from the results.
Before you have the test, check with your insurance provider to see if it is covered and how much you will have to pay out of pocket.
Some insurance companies, including government plans such as Medicare and Medicaid, will not pay for routine tests they deem unnecessary.
If the test is not covered, talk to your healthcare provider about less-expensive alternatives that might provide the same results.
Dr. William E. Kyle is an internal medicine physician at Memorial Health University Physicians, Legacy Center in Okatie.