Kaiser Health News (9/13, Boodman) reports that “increasingly, questions are being raised about the overtesting of older patients, part of a growing skepticism about the widespread practice of routine screening for cancer and other ailments of people in their 70s, 80s and even 90s. Critics say there is little evidence of benefit — and considerable risk — from common tests for colon, breast and prostate cancer, particularly for those with serious problems such as heart disease or dementia that are more likely to kill them.” Some physicians and researchers argue that the tests “trigger a cascade of expensive, anxiety-producing diagnostic procedures and invasive treatments for slow-growing diseases that may never cause problems, leaving patients worse off than if they had never been tested.”

Blogfinger Medical Commentary:

When did your doctor last check your ears?

Too many doctors rely on testing as a substitute for doctoring.  They sometimes tell patients that they will order tests, while ignoring the basics of a good history and physical examination.  Then, when the tests come back negative, the process is over, often without solving the problem.

Just listening to the patient may result in an accurate diagnosis without the need for expensive testing. I know of a case where a primary physician, trained at Johns Hopkins, ordered $3,000.00 of heart tests on a patient without asking any heart-related questions about chest pains, shortness of breath or palpitations.  The doctor didn’t even listen to the patient’s heart. The situation was resolved by a cardiologist without any tests.   (Who says that care by specialists is more expensive than primary care?)    This is not about how smart a doctor is; it is about how well they do their job.  Doctors must worry more about the cost of care.

Testing is often misused, and the motives are not only about defensive medicine.  Sometimes it is about profits, ignorance or  sloppiness.  Much money could be saved under a new healthcare system if practice guidelines are intelligently applied in the best interest of patients.  However, guidelines need to be flexible and they need to be written by physicians—not bureaucrats.

Paul Goldfinger, MD, FACC