| January 11, 2006
Medpundit on the PSA: “It’s one of those tests that gets ordered more for legal reasons than for medical reasons.”
I completely agree. And yes, I’m going to bring up the Merenstein lawsuit again.
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Why can’t the different doctors’ organizations make a statement and state that PSA is useless for screening and is not recommened and make that the standard of care agreed upon by the majority of doctors. Seems like an easy and simple task.
Statements from “doctors’ organizations” are not an easy and simple task. Multiple agendas come into play. In the case of PSA testing, Urology groups will generally support PSA testing because abnormal PSA’s generate a lot of additional work for urologists. Oncologists and cancer advocacy groups support testing because cancer detection is their focus, and other medical issues are secondary. Primary care physicians take a more holistic and population-based approach, noting that for the average asymptomatic person seeking a health check-up, PSA testing is of very questionable if any benefit.
It seems that one problem is that the organizations supporting testing are the ones that are more likely to have more exposure. They are also viewed like “experts” in the field, so most people tend to believe them over general practitioner. They also seem to get more TV exposure. Besides “early detection” is such an attractive and intuitive idea.
There really needs to be more information in the media and the web about the uncertainty surrounding screening as well as the risks.Currently one can find this information if one looks for it, but the majority of popular websites are pro-testing. Maybe those of you who work for some group or clinic that has its own “educational” website can do something about it. No risk of lawsuits in that.One difference between PSA and other screening tests is that PSA is a blood test. So most patients don’t even notice the doctor ordered it unless it comes back high. With other tests there is a separate referral, so people know they are being tested and are more likely to ask about it or throw out the referral if they don’t want it. PSA gets lost somewhere among a bunch of stuff. So the only option a patient has nowadays is to learn about the tests doctor might order beforehand, than examine the referral and then firmly ask the doctor to cross out stuff we don’t want – thankfully, we still have a legal right to do so.
I’d like to hear from the MDs who read this blog: do YOU personally get a PSA for yourself as a screening test? That’s the acid test.
I don’t. And I won’t let my husband get one, either.
“Judges use previous case decisions to decide new cases, and right now the Merenstein case is the legal precedent regarding PSA testing.”
That’s a complete misunderstanding of how precedent works.
I’d like to hear from the MDs who read this blog: do YOU personally get a PSA for yourself as a screening test? That’s the acid test.I am a woman and I am not a doctor, but I have a question to you. Do you want your doctor to honestly give you the information that a test is probably useless and let you decide for yourself whether you want to do it anyway or do you want the doctor to just order it as part of the routine blood work without telling you anything? If the doctor did give you the information and you decided not to have this test based on the careful consideration of the information, shouldn’t you be responsible for whatever happens later? Even if you yourself don’t want to have the information and the choice, do you think there might be others who actually want to have a choice? In the particular case being described the doctor gave all of the information to the patient, the patient left and then sued the doctor.Maybe it is because I was born in another country, but this seems wrong to me. It also has implications for those of us who actually want to make our own decisions about what is good for us. This type of cases seem to say that patients are like my pet cat. I’d like to think I am slightly more intelligent than my cat, but this jury (and the “expert witness” in this case) seemed to disagree.
A few facts for you – I am sure the doctors here will correct me if I am wrong.1. Just because a cancer is found early doesn’t mean it will be cured. Most aggressive cancer is less likely to be found early – it is a simple math. So even if this particular plaintiff had a test, it is not a fact that his prognosis would be any different. Nobody can say for sure.2. Some cancers grow so slowly that they it wouldn’t make a difference if they are found earlier or later – you’ll still be cured. Same if the treatment is very effective in all stages. Yet some cancers never progress or at least progress so slowly that they will not cause you any problems in your lifetime. Yet, if they are found, you’ll be treated – and can become incontinent or/and impotent as a result. So screening is not without risks. 3.The question these studies are supposed to answer is whether there are cases in-between – those that grow sufficiently slow that the early diagnosis would save your life yet not so slow as to never cause you any problems. If this is the case, than less screened people should die from this cancer than non-screened. PSA studies haven’t shown that. Note, that even had these studies shown some benefit, I personally would still want to evaluate for myself if the benefit (which is likely to be small in absolute numbers) for me personally is worth the risk of being treated for something that would never threaten my life. I am sure this decision will be different for other people, but who are you or me to say what is right or wrong for others?
Don’t you think we as patients are intelligent enough to know what is good for ourself and have a right to make our own decisions? If we make our own decision, don’t you think we have responsibility to live with the consequences?
I don’t know where this last blast came from, but the question still stands: for all you MDs who scoff at those of us who want certain screening tests that you MDs say don’t work, **do you have the test done on yourself**? Simple question when it comes to the PSA test. The response provides a data point for me to evaluate the MD’s recommendation. Anybody want to answer?
Anon at 5:23 did.
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