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Beware Unnecessary Medical Care

CT scans, in particular, may do more harm than good

Have you ever wondered whether the CT scan you were given was really necessary? If so, you are not alone. Unnecessary care, defined by the Institute of Medicine as treatment that yields no benefit and may cause more harm than good, is common. About one-third of people surveyed by Harris Interactive for the Commonwealth Fund reported they had tests, treatments or drugs they thought were unnecessary or duplicative. Among those who described their health as fair or poor, 40 percent said they had care that was unnecessary.
Doctors agree, apparently. A study published last fall in the Archives of Internal Medicine revealed that 42 percent of primary care doctors surveyed said patients in their own practice receive too much medical care. Six percent said their patients receive too little care and 52 percent said they provide just the right amount of care. Reasons cited for providing unnecessary care included malpractice concerns (76 percent of those who said they provide too much care), performance measures that require them to do tests or procedures when not warranted (52 percent), and inadequate time to spend with patients (40 percent), leading them to order a test instead. Further, 62 percent of survey respondents said financial incentives encourage medical specialists to do unwarranted testing.
CT scan overload
CT scans are a good example of where overuse can cause harm. Each year 70 million CT scans are performed. While they provide valuable information, the radiation exposure can be 50 to 500 times higher than that of a standard X-ray, which increases the risk of cancer. Researchers at the National Cancer Institute estimate that 29,000 radiation-induced cancers will occur each year from CT scans, and two-thirds of them will be in women.
A case in point: A young woman in New Jersey who experienced periodic bouts of abdominal pain went to a hospital emergency department on multiple occasions when the pain flared up. At each visit, doctors performed a CT scan, none of which revealed any explanation for her symptoms.
When she went to the emergency department again for the same complaint, a seasoned internist at the hospital examined her and quickly suspected lead poisoning, whose telltale sign can be belly pain. A simple blood test confirmed the diagnosis. The doctor reviewed her medical record and found that nine CT scans had been performed in search of a diagnosis for her complaint. She had been exposed to enormous amounts of radiation unnecessarily.
Other culprits
Many other tests, surgeries, drugs and other treatments are overused, including unnecessary heart screening tests. A list of overused interventions has been compiled by physicians as part of the National Priorities Partnership, a group whose aim is to provide better care.
To encourage doctors to use tests and treatments appropriately, the American Board of Internal Medicine Foundation, a Philadelphia-based group whose mission is to promote professionalism in medicine, launched its Choosing Wisely campaign in December 2011. The aim is to help patients choose tests and treatments that are truly necessary and supported by research. The group is quick to point out that curbing overuse is not rationing, which is the denial of medical care that provides a benefit.
To help you choose wisely, here are five things you can do when facing a decision about a CT scan:
  • Know that a CT scan has benefits and risks. It can be a great diagnostic tool if you need it, but can pose unnecessary risk if you don’t.
  • Ask your doctor whether the information from the scan is likely to change how he or she manages your condition. If not, you should question whether it is necessary.
  • Find out if there is an alternative way to diagnose a condition that doesn’t involve radiation, such as an MRI or ultrasound.  
  • Avoid duplicate tests by keeping track of the diagnostic imaging tests you have had, the date when you had them, and the facility where they were performed.   
  • Check this website, developed by the Radiological Society of North America and the American College of Radiology to learn the amount of radiation exposure associated with CT scans of the head, chest, abdomen and other parts of the body. This information will help you estimate your cumulative radiation exposure and discuss any concerns with your doctor.

You can take similar steps. Get information about the risks and the benefits; talk to your doctor about alternatives; keep track of your imaging tests (you can also ask for copies). Today’s health care is not your grandmother’s health care. Get the care you need, no more and no less.

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