Are doctors ordering the right tests?

In many cases, no. Pathologist Brian Jackson brings up some good points on unnecessary testing. He cites PSA test screening for prostate cancer. By itself, the test is $20, but false positives can lead to an unnecessary $1,000 prostate biopsy or $10,000 prostatectomy.

Currently, both financial and legal incentives propel doctors to order more tests, whether they are needed or not. Removing both these drivers will be the most effective way to clamp down on unnecessary testing.

Comments

Dr. Wes
Pathologists always have the benefit of knowing if a screening test was ultimately a false positive since they look at the specimen in a pan before them. Hind sight is always 20/20. Suggesting that no one should pay for “unnecessary surgery” misses the point once the potential for cancer exists and doctors are compelled to act. Maybe the pathologists should devise a better test?
Anonymous
IMO both pathologists and radiologists suffer from their lack of direct patient interaction. It is easy to say in hinbdsight from the comfort of a lab or dark room as to what should or should not be done. It is a little different directly in front of the patient in real time
Dr. K
There are 2 clinical trials that should answer whether PSA holds any value as a screening test for prostate cancer:
1. PCOS (Prostate Cancer Outcomes Study)
In 1994, the National Cancer Institute (NCI) started the Prostate Cancer Outcomes Study (PCOS) to investigate the impact of treatments such as radical prostatectomy (removing the prostate), radiotherapy, and hormonal therapy, versus no treatment (watchful waiting) on death rates from prostate cancer as well as quality of life issues. By looking at the health outcomes of prostate cancer treatments, the goal of the study is to provide patients, their families, and physicians information to make decisions about which treatment options are best for their situation. The results of this study are ongoing and will be published in various medical journals over the next few years (http://www.cancer.gov/cancertopics/factsheet/pcos).
2. PLCO (Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial
Sponsored by the National Cancer Institute (NCI), the goal of this sixteen-year study is to determine whether screening tests for prostate (using PSA and DRE), lung, colorectal, and ovarian cancer will reduce the number of deaths from these cancers. Results of this trial should be available within the next few years (http://www.cancer.gov/cancertopics/factsheet/PLCOProstateFactSheet) .
Until then patients should be counseled about the ramifications of having that tube of blood drawn. PSA is not diagnostic of prostate cancer, only a biopsy can diagnose prostate cancer-which means an invasive procedure. This is recommended by United States Preventive Services Task Force.
Skibjork
Interesting post by Healthcare-Economist.com today touching somewhat on these same points (link below). Agreed that pathologists aren’t with the patient, but they see what the doctors are ordering for the patients and they know when something could be done better. The hurdle is finding that communication bridge between the two parties.
http://healthcare-economist.com/2008/11/07/us-spends-700-billion-on-unnecessary-medical-tests/

Are doctors ordering the right tests?

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