Most Americans think the more medical tests you do, the better off you are.
Why not test? What could possibly go wrong?
One reason HMOs got a bad name was the perception that doctors in these health maintenance organizations didn’t do enough testing in an effort to keep costs down. I remember telling one patient she didn’t need a head CT for her headache only to have her respond: “I bet you’re not doing that test because you’ll make more money.”
Smart testing is right. Overtesting is wrong. It’s dangerous.
Now, a recently published study in the Journal of the American Medical Association points out the dangers of CT tests in children. It’s radiation – that’s the culprit.
Exposure to radiation is risky. It’s a small risk, I’ll grant you that, but a risk nonetheless. And radiation from a CT is far greater than radiation from a regular X-ray.
Radiation takes lots of time to do its dirty tricks. So if you’re a 70-year-old, getting that extra CT probably won’t affect your life much because you won’t be around long enough to experience the effects. But if you’re a 5-year-old who stands to be around for 80 more years, it’s a different story.
It’s all about cancer, cancer, cancer. Researchers calculated how many “potential” tumors are caused by CT scans. They estimated that every year, 5,000 extra cancers are triggered in children to be developed sometime in their adult life, perhaps 40 to 50 years down the road.
We are taking three times as many CTs in children today as we were 15 to 20 years ago. Is this good medicine? Not according to JAMA’s editorial titled “The Harm in Looking.” By the way, the risk of getting leukemia from a head CT is one in 5,000. That doesn’t seem like much unless the “one” is your child – then it’s 100 percent, isn’t it?
Back when I worked in the ER, we rarely took CT scans at night because we had to call in the radiologist and technicians. We only did these tests when they were absolutely necessary. These days, we have 24/7 medicine, so every head injury gets a CT scan.
Why do we do so many? Some doctors are worried about malpractice – they don’t want to be accused of not doing enough. Others have moved away from intelligent clinical judgment, thinking they need to verify everything with a test and taking the attitude “what could possibly go wrong?”
Also, our patients demand it. We have come to disrespect medical judgment in favor of the technological imperative. Patients think: If there’s a test, I must have it; otherwise, doctor, you are not doing a good job.
Bottom line: It’s time to stop this silliness. If a doctor recommends an X-ray or CT scan for you or your child, ask them the following two questions:
• Can you make the diagnosis without this test?
• Would you take this test yourself or give it to your own child?
If the answer is “yes” to the first question and “no” to the second, then it’s probably a needless test. Thank the doctor and tell him or her you’re comfortable with their clinical judgment. Ask what went into their thinking. And also say thanks for making the diagnosis without a needless test.
A good clinician will smile gratefully and say, “You’re welcome.” It’s a win-win situation.
Dr. Zorba Paster is a family physician, university professor, author and broadcast journalist. He also hosts a radio program at 3 p.m. Saturdays on WBFO-FM 88.7.