An embarrassment to evidence-based medicine

A simple question asks what does a “routine physical” entail leads to an explosion of referrals and unnecessary test suggestions:

Q: What further referrals might be suggested?

A: Depending on your risk factors, a referral to a gastrointestinal specialist may be ordered for colon-rectal cancer screening, a referral to a cardiologist for heart disease screening, an eye doctor to evaluate for glaucoma, a diabetes doctor for evaluation of high blood sugar, a referral to a gynecologist for a pap smear, mammogram or hormone therapy, and referral to orthopedic for evaluation of bone problems.

Q: What further diagnostic test may be recommended?

A: Depending on each person, the following may be ordered: chest X-ray, blood test to evaluate for anemia, electrolytes, cholesterol, diabetes, liver tests, stress test, bone density and prostate test.

Let me go through these suggestions – I previously wrote about unnecessary testing a few weeks ago.

colon cancer screening: agreed
heart disease screening: not routinely recommended
diabetes screening: agreed
Pap smear/mammogram: agreed
“hormone therapy”: uh, not after the recent results of the WHI study
CXR: not routinely recommended
anemia: not routinely recommended
electrolytes: not routinely recommended
cholesterol: agreed
liver tests: not routinely recommended
stress test: not routinely recommended
bone density: agreed
prostate test: agreed

I’m pretty sure this doctor has never heard of the USPSTF and simply perpetuates the common notion that “more medicine is better medicine”. It’s physicians like Dr. Sangani who sink evidence-based medicine today.

A reader appropriately pointed out the prostate cancer screening is a class C USPSTF recommendation. That’s true, so I’ll amend my comments:

“prostate test: agreed, after discussion of the pros and cons with the patient”

Apologies. My mind reflexively thinks back to the Merenstein prostate cancer screening malpractice case whenever I discuss PSAs.