**********************************
You may assume your doc is being thorough when she runs a gazillion tests, but there's a downside to being too proactive. New studies show that many people don't benefit from costly screening tests that come with pitfalls such as false positives and excessive radiation. So doctors tend to do fewer of them. Here are some tests you may be able to skip (for a full list, go to choosingwisely.org
.) Bone-density test
Aside from those who are at high risk for weak bones
,
women should wait until they are 65 to have their bone density
measured. Younger women are unlikely to have outright osteoporosis, and
while the scan may detect mild bone loss (osteopenia), the risk of a
fracture is low and the drugs that may be prescribed to treat this
condition carry side effects and haven't proved to be highly beneficial
in these cases.CT scan or MRI, for headaches
Most of the time a careful medical history and a neurological exam (e.g., measuring reflexes) can diagnose the problem. And CT scans involve a hefty dose of radiation.
EKG or exercise stress test
Hooking up to an electrocardiogram (EKG) and/or taking an exercise stress test makes sense if you have symptoms of heart disease or are at high risk, but those at low risk who are just looking for reassurance may get inaccurate results that can lead to further testing and overtreatment with drugs.
Imaging for lower-back pain
You don't want to skip an X-ray, CT scan or MRI if there are signs of a severe problem (a history of cancer, fever or pain that lasts several weeks), but lower-back pain
often gets better in about a month.PET/CT for cancer screening in healthy people
The likelihood of finding cancer in healthy adults using these screening methods is extremely low, according to the Society of Nuclear Medicine and Molecular Imaging.
****************************************
The problem, as I see it, is that doctors are no trained to be good clinicians or good at diagnostics. They rarely listen to what patients actually say and instead latch onto keywords, much like a Google search engine, and then spew out an array of suggestions in the form of "tests". Also like Google, most of these suggestions are not satisfactory and other attempts are made by changing the wording just slightly.
ReplyDeleteAs a person with chronic pain and a rare autoimmune disease, I know just how frustrating it is when "specialists" do not listen, approach me as a series of parts rather than a whole, and forget that I have a fully functioning brain in my head. I am the expert on my situation/ experience. I've been living with myself for a long time now and I know what's changed and what hasn't and when. When I find a doctor who has that old-school bedside manner - i.e. they listen and ask questions for clarification then use THEIR brains instead of ticking off the boxes on a form. Yes, it takes more time. Yes, it involves actually thinking and possibly being wrong. But it also involves creating a relationship that can be so helpful as to be partially healing in itself. Being heard and being believed is such a relief; stress levels reduce and that DOES make me feel somewhat better.
Excellent piece, Kevin. Finding a good doctor is like finding a good mechanic. They are not created equal and you have the right to choose.
The middle of the second paragraph should read:
DeleteWhen I find a doctor who has that old-school bedside manner - i.e. they listen and ask questions for clarification then use THEIR brains instead of ticking off the boxes on a form - I try to stay with them for as long as possible. Because I have done so much contract work over the years, I tend to move every few years and it becomes increasingly difficult to find these older, brilliant clinicians.
Please excuse the typos!
ReplyDelete