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Wednesday, Jan 22, 2020

Ask your doc if you really need that test

Hospitals are almost always bad news. Irrespective of whether you are sicker than a drunk skunk or fitter than a professional footballer, a visit to modern temples of wellness always leaves you a lot poorer. Sanchita Sharma writes.

india Updated: Apr 07, 2012 23:14 IST
Sanchita Sharma
Sanchita Sharma
Hindustan Times

Hospitals are almost always bad news. Irrespective of whether you are sicker than a drunk skunk or fitter than a professional footballer, a visit to modern temples of wellness always leaves you a lot poorer.

When it comes to demanding tests, doctors behave like deprived teens set loose in a gadget store. They want everything that's there, and some things that are not. And like reluctant parents, you pay they bill. Calling doctors technology-oriented is a kindness as many have turned into technicians who rely more on tests than skill for diagnosis.

The result? You are screened and tested when you are ill, and you are screened and tested before being declared fit. You may not get a clear diagnosis for a disease or disorder, but you always get a fat file of medical reports along with a stroke-inducing bill. You can't win this one.

The reason for this all-pervasive technology-dependency could be one or more of any. The doctor may want to be regarded as technologically updated, he could be worried about being sued and abused, or he could simply be unconfident about getting the diagnosis right. Whatever the cause, the rising over-caution and the need to take refuge in 'defensive medicine' by prescribing tests to rule out every disorder and disease listed in the updated medical almanac is a worrying trend.

Unnecessary tests and procedures find top place on the list of things that send medical costs soaring. As many as one in three are not needed, found a large US study this week. At best, they have no benefit, but at times, they can harm.

To scrap these avoidable costs, the American Board of Internal Medicine Foundation along with nine medical associations released a list of 45 common tests, procedures and medicines that lack scientific validation and should be avoided.

Among the tests ruled out are several we consider very basic, such as X-rays for low back pain, which affects one in two people at some point of their lives. Unless red flags - such as acute or shooting pain that signifies a serious or degenerative disease - doctors say X-rays have no use in diagnosis and the ensuing treatment.

Experts have also ruled out CT or MRI scans of the head after a fainting spell unless signs of a seizure are present, along with CT scans for appendicitis in children because less expensive ultrasound scans are just as accurate for diagnosis.

Again, stress tests - a staple of all heart screening packages - are not needed for healthy people unless the patient has diabetes or other heart risk factors, just as antibiotics are not needed for sinus infections and sore throats as a chunk of these infections are not caused by bacteria, against which antibiotics work. In such cases, misuse and overuse of antibiotics can lead to drug-resistant strains of bacteria, such as the now infamous New Delhi metallo-beta-lactamase (NDM-1) and the methicillin-resistant Staphyloccus aureus (MRSA), which are almost impossible to treat.

For cancers too, experts recommend that PET, CT and bone scans to determine spread of early prostate and breast cancers should be avoided if the tumours are low grade - meaning there is a low risk of metastasis or spreading to another location - as such scan lead to unnecessary surgery, radiation and chemotherapy.

Of course, tests and procedures are often essential for diagnosis and, in medicine, erring on the side of caution is preferable to possible death. So the point of the whole 'defensive medicine' debate is the growing need to ask your doctor if the test prescribed is really necessary. If the answer is yes, go ahead. If it's no, don't insist on it. You can put the money and the worry saved to better use.