Comments on: My take: Just say no to unnecessary tests http://www.kevinmd.com/blog/2008/04/my-take-just-say-no-to-unnecessary.html Tue, 14 Feb 2012 20:59:00 +0000 hourly 1 By: Anonymoushttp://www.kevinmd.com/blog/2008/04/my-take-just-say-no-to-unnecessary.html#comment-113534 Anonymous Thu, 08 Oct 2009 13:47:57 +0000 http://clients.emmense.com/kevinmd/2008/04/my-take-just-say-no-to-unnecessary-tests.html#comment-113534 Of course it's easier to tell a patient something <i>might</i> be wrong while covering your a** and making a little extra money too. Every human on the planet <i>might</i> have every disease in the book, so why not check everybody for everything? It makes me so mad. Of course it’s easier to tell a patient something might be wrong while covering your a** and making a little extra money too. Every human on the planet might have every disease in the book, so why not check everybody for everything?
It makes me so mad.

]]> By: Health Highlights – May 6th, 2008 | Highlight HEALTHhttp://www.kevinmd.com/blog/2008/04/my-take-just-say-no-to-unnecessary.html#comment-112583 Health Highlights – May 6th, 2008 | Highlight HEALTH Thu, 24 Sep 2009 01:55:33 +0000 http://clients.emmense.com/kevinmd/2008/04/my-take-just-say-no-to-unnecessary-tests.html#comment-112583 [...] My take: Just say no to unnecessary tests | Kevin, M.D. [...] [...] My take: Just say no to unnecessary tests | Kevin, M.D. [...]

]]> By: Georgettehttp://www.kevinmd.com/blog/2008/04/my-take-just-say-no-to-unnecessary.html#comment-111423 Georgette Tue, 08 Sep 2009 16:49:53 +0000 http://clients.emmense.com/kevinmd/2008/04/my-take-just-say-no-to-unnecessary-tests.html#comment-111423 My son had an MRI on his legs to diagnose some long-standing (>10years) lumps on his leg. The MRI came back negative but the radiologist recommended another MRI with contrast to rule out the remote possibility of cancer. I refused just as much because of the remote possibility as for my son's inability to tolerate another MRI. His podiatrist agreed with my decision saying he had to order it as protective medicine just because the radiologist recommended it. Hey folks an MRI costs more than $3,000! My son had an MRI on his legs to diagnose some long-standing (>10years) lumps on his leg. The MRI came back negative but the radiologist recommended another MRI with contrast to rule out the remote possibility of cancer. I refused just as much because of the remote possibility as for my son’s inability to tolerate another MRI. His podiatrist agreed with my decision saying he had to order it as protective medicine just because the radiologist recommended it. Hey folks an MRI costs more than $3,000!

]]> By: andrewhttp://www.kevinmd.com/blog/2008/04/my-take-just-say-no-to-unnecessary.html#comment-109974 andrew Thu, 20 Aug 2009 19:47:08 +0000 http://clients.emmense.com/kevinmd/2008/04/my-take-just-say-no-to-unnecessary-tests.html#comment-109974 Tests are like Tribbles. One leads to another, and another and another. Tests are like Tribbles. One leads to another, and another and another.

]]> By: dennishttp://www.kevinmd.com/blog/2008/04/my-take-just-say-no-to-unnecessary.html#comment-109226 dennis Tue, 11 Aug 2009 06:19:49 +0000 http://clients.emmense.com/kevinmd/2008/04/my-take-just-say-no-to-unnecessary-tests.html#comment-109226 The key point in all this is the word 'unnecessary'. It is very important to be able to tell when a particular test is deemed needed or not.I've learned this after my transplant, and tests that seemed unnecessary and repetitive being done on a monthly or bi-monthly schedule aren't unnecessary at all.So what it really comes down to is what is necessary and what excessive. The key point in all this is the word ‘unnecessary’. It is very important to be able to tell when a particular test is deemed needed or not.

I’ve learned this after my transplant, and tests that seemed unnecessary and repetitive being done on a monthly or bi-monthly schedule aren’t unnecessary at all.

So what it really comes down to is what is necessary and what excessive.

]]> By: Dr York Yateshttp://www.kevinmd.com/blog/2008/04/my-take-just-say-no-to-unnecessary.html#comment-91826 Dr York Yates Fri, 05 Jun 2009 04:17:18 +0000 http://clients.emmense.com/kevinmd/2008/04/my-take-just-say-no-to-unnecessary-tests.html#comment-91826 Great post.Obviously there are certain tests that are invaluable in the diagnosis and treatment of a patient. Where this becomes a problem is when a physician orders a test with their own economic advantage as one of the factors involved with ordering the test. It sounds ridiculous that in the most noble and selfless of professions that many tests that are being ordered are largely done because physicians make money based on tests. There should be a way to regulate the bad apples such as auditing practice patterns. I am a plastic surgeon, so admittedly I have fewer tests that I would routinely order. I have seen many patients whom have been sent to me with an obviously benign "lump" in a hand or wrist that is clearly a simple ganglion cyst that have had an MRI in the workup, which is completely unnecessary for diagnosis or treatment. Lets all be responsible.If the results of a test do not change the treatment. DON'T order it!My 2 cents. Great post.

Obviously there are certain tests that are invaluable in the diagnosis and treatment of a patient. Where this becomes a problem is when a physician orders a test with their own economic advantage as one of the factors involved with ordering the test. It sounds ridiculous that in the most noble and selfless of professions that many tests that are being ordered are largely done because physicians make money based on tests. There should be a way to regulate the bad apples such as auditing practice patterns. I am a plastic surgeon, so admittedly I have fewer tests that I would routinely order. I have seen many patients whom have been sent to me with an obviously benign “lump” in a hand or wrist that is clearly a simple ganglion cyst that have had an MRI in the workup, which is completely unnecessary for diagnosis or treatment. Lets all be responsible.

If the results of a test do not change the treatment. DON’T order it!

My 2 cents.

]]> By: Michael Kirsch, M.D.http://www.kevinmd.com/blog/2008/04/my-take-just-say-no-to-unnecessary.html#comment-91190 Michael Kirsch, M.D. Wed, 06 May 2009 16:37:00 +0000 http://clients.emmense.com/kevinmd/2008/04/my-take-just-say-no-to-unnecessary-tests.html#comment-91190 Unneccessary medical care? The health care crisis will never be solved without taming this elephant in the health care reform room. For a physician's explanation why so many CAT scans are ordered, check out http://mdwhistleblower.blogspot.com/2009/04/understanding-cat-scan-cascade.html.<br /><br />More medical are often means less medical quality. Unneccessary medical care? The health care crisis will never be solved without taming this elephant in the health care reform room. For a physician’s explanation why so many CAT scans are ordered, check out http://mdwhistleblower.blogspot.com/2009/04/understanding-cat-scan-cascade.html.

More medical are often means less medical quality.

]]> By: Anonymoushttp://www.kevinmd.com/blog/2008/04/my-take-just-say-no-to-unnecessary.html#comment-89642 Anonymous Fri, 06 Feb 2009 00:06:00 +0000 http://clients.emmense.com/kevinmd/2008/04/my-take-just-say-no-to-unnecessary-tests.html#comment-89642 I agree....I've always been concerned about cancer screening.<br/>I won't agree to it unless I'm convinced the benefit outweighs the risk...then I look at my risk profile.<br/>Sometimes that takes time...but I refuse to be railroaded...<br/>Most cancer screening tests have risks - you can be harmed and alarmed by a false positive...<br/>you need to know how common is this cancer, how reliable is the test, % of false positives and false negatives and what are MY chances of getting this cancer...<br/>Otherwise, you'll be herded into the test with everyone else...<br/>I don't accept vague answers...<br/><br/>I'm afraid I don't trust the medical profession to give me an honest and unbiased overview of a test...<br/>I was told cervical cancer was common...that's not true, it's an uncommon cancer affecting 1% of women (according to a Report from the College of Pathologists) - of that 1% - one third will have received false negatives, so screening did not help them, in fact, it may have delayed their diagnosis because the woman was reassured by the Test result and ignored symptoms)...<br/>So, 0.66% will benefit from the screening (in a big way) - for the other 99.33%....L. Koutsky's research showed with two yearly screening almost 78% will have a colposcopy and possibly, biopsies with only a very small number having malignancy - Annual screening - 95%...<br/>So, it becomes a question of containing the harm to healthy people.<br/>This information is vitally important IMO to assess the risk of the cancer, the value of the screening and the risks and value of the test FOR YOU....<br/><br/>So, often we're bullied, pushed into or "required" to have these Tests - that's wrong...<br/>No one has the right to assume risk on your behalf...and each of us will be happy to carry a different amount of risk and be accepting of the risk of false positives etc...<br/>Cancer screening is being "offered" to healthy people, so IMO the Dr is morally and ethically obliged to give you full and frank information and leave the decision up to the patient... I agree….I’ve always been concerned about cancer screening.
I won’t agree to it unless I’m convinced the benefit outweighs the risk…then I look at my risk profile.
Sometimes that takes time…but I refuse to be railroaded…
Most cancer screening tests have risks – you can be harmed and alarmed by a false positive…
you need to know how common is this cancer, how reliable is the test, % of false positives and false negatives and what are MY chances of getting this cancer…
Otherwise, you’ll be herded into the test with everyone else…
I don’t accept vague answers…

I’m afraid I don’t trust the medical profession to give me an honest and unbiased overview of a test…
I was told cervical cancer was common…that’s not true, it’s an uncommon cancer affecting 1% of women (according to a Report from the College of Pathologists) – of that 1% – one third will have received false negatives, so screening did not help them, in fact, it may have delayed their diagnosis because the woman was reassured by the Test result and ignored symptoms)…
So, 0.66% will benefit from the screening (in a big way) – for the other 99.33%….L. Koutsky’s research showed with two yearly screening almost 78% will have a colposcopy and possibly, biopsies with only a very small number having malignancy – Annual screening – 95%…
So, it becomes a question of containing the harm to healthy people.
This information is vitally important IMO to assess the risk of the cancer, the value of the screening and the risks and value of the test FOR YOU….

So, often we’re bullied, pushed into or “required” to have these Tests – that’s wrong…
No one has the right to assume risk on your behalf…and each of us will be happy to carry a different amount of risk and be accepting of the risk of false positives etc…
Cancer screening is being “offered” to healthy people, so IMO the Dr is morally and ethically obliged to give you full and frank information and leave the decision up to the patient…

]]> By: Anonymoushttp://www.kevinmd.com/blog/2008/04/my-take-just-say-no-to-unnecessary.html#comment-89352 Anonymous Thu, 22 Jan 2009 12:30:00 +0000 http://clients.emmense.com/kevinmd/2008/04/my-take-just-say-no-to-unnecessary-tests.html#comment-89352 As a doctor I have been telling my patients time and time again that I treat patients not laboratory results.<br/><br/>Too much dependency on laboratory test dulls the clinical eye of the physician, at least in my opinion. Tests should support or rule out our differential diagnosis and should be ordered based on the patient's history of illness and physical examination.There is no such thing as a "routine" test.<br/><br/>Screening tests are ordered on a specific subset of the patient population and should be done as benefits these tests are supported by legitimate studies. But in the end, I go back to my first statement : I treat patients, not lab results. As a doctor I have been telling my patients time and time again that I treat patients not laboratory results.

Too much dependency on laboratory test dulls the clinical eye of the physician, at least in my opinion. Tests should support or rule out our differential diagnosis and should be ordered based on the patient’s history of illness and physical examination.There is no such thing as a “routine” test.

Screening tests are ordered on a specific subset of the patient population and should be done as benefits these tests are supported by legitimate studies. But in the end, I go back to my first statement : I treat patients, not lab results.

]]> By: Anonymoushttp://www.kevinmd.com/blog/2008/04/my-take-just-say-no-to-unnecessary.html#comment-88223 Anonymous Tue, 18 Nov 2008 05:49:00 +0000 http://clients.emmense.com/kevinmd/2008/04/my-take-just-say-no-to-unnecessary-tests.html#comment-88223 **Granted, many tests are beneficial. Screening studies looking for abnormal cholesterol levels, colon cancer, breast cancer and cervical cancer have been shown to save lives**<br/><br/>It is my understanding that testing for cholesterol and breast cancer have pretty conclusively shown no mortality benefit in asymptomatic individuals. This is from books by physicians who teach at Dartmouth, UNC and Columbia. Do you have information they do not have? **Granted, many tests are beneficial. Screening studies looking for abnormal cholesterol levels, colon cancer, breast cancer and cervical cancer have been shown to save lives**

It is my understanding that testing for cholesterol and breast cancer have pretty conclusively shown no mortality benefit in asymptomatic individuals. This is from books by physicians who teach at Dartmouth, UNC and Columbia. Do you have information they do not have?

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