SEARCH

Entries in MRIs (3)

Thursday
Apr052012

Doctors: Extra Tests Not Key to Best Patient Care

Comstock/Thinkstock(NEW YORK) -- In an effort to end medical over-testing, nine major medical professional organizations have banded together to try to change the way doctors use tests and procedures once considered fairly routine.

The campaign, Choosing Wisely, a joint effort led by the American Board of Internal Medicine Foundation and Consumer Reports, released a list of 45 common tests and procedures it hopes will be more carefully prescribed and performed.

The campaign is a frank attempt by a wide consortium of medical groups to address what many characterize as rampant, wasteful procedures and spending in the U.S. health care system.

"The distinction to be drawn is between 'care' and 'tests,'" said Dr. Thoralf Sundt, chief of cardiac surgery at Massachusetts General Hospital.  "Doing tests is not the same as providing care in all instances."

Several of the over-used tests called out by the specialty organizations are procedures that have long been considered routine or harmless by many.  Staples such as cardiac stress tests or chest x-rays before minor surgery got the thumbs down from several of the groups.

Some of the recommendations are not radically different from what other groups have been saying for years.  Several guidelines, such as those recommending against Pap tests for women under age 21 or bone density scans for women before age 65, have recently been publicized by the U.S. Preventive Services Task Force, the government body charged with reviewing and recommending health care processes.

But many doctors say that the endorsement of less testing by the heavyweight medical specialty groups may just resonate with more physicians and could alter what has been routine practice.

"It is important because it signals from physician leadership that there is waste in the system that should and could be reduced," said Dr. Harlan Krumholz, professor of investigative medicine and public health at Yale University School of Medicine.  "And it should be just the beginning of a movement."

Many doctors do such screenings and procedures for a variety of reasons other than patient care, doctors say.  Often the reason is simple: a given test or procedure is what the doctor has always done.

Others feel that ordering a barrage of tests will yield the source of a patient's problem, or will reveal an unknown danger.  Other doctors use tests defensively, out of fear that not ordering a test could look like negligence and prompt a lawsuit.

"After a while, getting a CT for a headache or fainting spell even without any neurologic deficits or a stress test for asymptomatic patients becomes the de facto 'standard of care' and physicians are afraid to miss something lest they be sued," said Dr. John Messmer, associate professor of family and community medicine at Penn State College of Medicine.

But experts say it's time to drop this just-in-case mindset.

Reframing conventional medical thinking about testing would likely be a money-saver for the U.S. healthcare system. Some research groups estimate that excessive, unnecessary testing and procedures account for as much as one-third of U.S. medical spending, which totaled more than $2 trillion in 2009 alone.

Copyright 2012 ABC News Radio

Wednesday
Apr042012

Five Medical Tests You May Not Need

Keith Brofsky/Thinkstock(NEW YORK) -- A routine visit to the doctor's office can bring up a laundry list of medical tests, all designed to screen for one serious disease or another.  But according to a new report from leading physician groups, a large number of medical tests and procedures billed as routine are largely unnecessary.

For many patients and doctors, it's easy to adopt the notion that if a little screening is good, more of it is better, "just to be sure" nothing is wrong.  But that approach is costly, both in terms of health care dollars spent and the potential risks of the screenings.

"There's no medical treatment or test that is 100 percent without risk," said Dr. Christine Cassel, president and chief executive officer of the American Board of Internal Medicine Foundation.  "Things that you might think are routine actually should not be done because they expose patients to risk."

To help patients parse through the barrage of medical procedures, the ABIM Foundation and Consumer Reports have created the Choosing Wisely project, a campaign that asked nine physician groups to identify five tests or procedures in their fields that are over used or unnecessary.

Cassel said the project is designed to give patients as much information as doctors have about screening, as well as to rein in health care costs.

The full list was published on Wednesday, but here's a look at five common tests you may not need:

Cardiac Stress Test


Cardiac stress tests were once considered a staple of routine check-ups.  Also called the treadmill test or an exercise EKG, doctors often use it to determine if a patient has blocked arteries.  The U.S. Preventive Services Task Force has long recommended that people at low risk for cardiovascular disease and with no symptoms of heart trouble don't need an annual stress test.  But a 2010 Consumer Reports survey of 8,000 people ages 40 to 60 found that 44 percent of low-risk people with no symptoms had been screened.

According to the American College of Cardiology, stress tests should only be performed on patients who have peripheral artery disease, diabetics over age 40 and people who have an increased risk of coronary artery disease.

Chest X-rays Before Minor Surgery

For many years, chest x-rays were another nuts-and-bolts part of hospital care.  But the test is going by the wayside.  The American College of Radiology said for most patients undergoing outpatient procedures, the tests are unnecessary. 

Some people should get a chest x-ray before going under the knife, such as those with a history of heart problems, lung disease or cancer.  For others with a normal physical exam, the ACR said the test leads to a change in patient care in only two percent of cases.

Imaging Tests for Lower Back Pain

According to the American Academy of Family Physicians, lower back pain is the fifth most common reason for all visits to the doctor's office.  But unless a patient has certain red flags of a deeper physical problem, such as spinal abnormalities or neurological problems, the AAFP and the American College of Physicians say doctors shouldn't use MRIs, CT scans or other imaging to investigate lower back pain.

Frequent Colon Cancer Screenings

Colonoscopies, perhaps the most unloved cancer screening, are a necessary aspect of health care after age 50.  A recent study found that having precancerous growths spotted on colonoscopies removed cut the death rate from colon cancer by 53 percent. 

Most major medical groups recommend that people over 50 get a colonoscopy every 10 years.  However, the key is moderation.  According to the American Gastroenterological Association, most adults who are at an average risk of colon cancer and who get a clean bill of health from a colonoscopy don't need another one for the next decade -- good news for health care pocketbooks, since the test costs an average of $1,050.

Bone Density Scans

Osteoporosis becomes a real risk for people, particularly women, with increasing age.  The National Institutes of Health estimates that one in five women over age 50 has osteoporosis.  But patients may want to ask their doctors how often they need a bone density scan to screen for signs of the disease.

The American Academy of Family Physicians echoes the U.S. Preventive Services Task Force in recommending that only women over age 65 get a bone mineral density test, called dual-energy x-ray absorptiometry, or a DEXA scan.  The AAFP also recommends the test for men age 70 and older, although the USPSTF said there is insufficient evidence to balance the risks and benefits of screening men for osteoporosis. 

The test costs more than $100, and unless a woman under age 65 has additional risk factors, such as smoking, an eating disorder or previous broken bones, doctors say the scan is unnecessary.

Copyright 2012 ABC News Radio

Tuesday
Apr032012

Ultrasounds, MRIs Can Find More Breast Cancer, Says Study

iStockphoto/Thinkstock(PITTSBURGH) -- Here's one more study to add to the breast cancer screening debate: Annual mammogram screenings, combined with ultrasounds and MRIs, significantly increase the detection of cancer in women who had an elevated risk of breast cancer, new research has found.

Scientists at the University of Pittsburgh School of Medicine examined data from the American College of Radiology Imaging Network trial. Out of more than 2,600 women who were at increased risk of breast cancer (they had dense breast tissue and at least one other risk factor, such as a family history of the disease), 53 percent of the cancers were detected through mammograms. Ultrasounds picked up 33 additional cases of breast cancer, and MRIs found nine more that were not detected by either ultrasounds or mammograms.

"For women with dense breasts who are at higher risk, cancers tend to be more advanced," said Dr. Wendie Berg, the trial's principal investigator and professor of radiology at the University of Pittsburgh School of Medicine. "The combination of ultrasound and mammography is quite effective in finding the cancers."

The research was published Tuesday in the Journal of the American Medical Association and funded by the Avon Foundation and the National Cancer Institute.

While women with dense breast tissue may be at higher risk of developing breast cancer, the conundrum is compounded by the fact that mammograms are less likely to detect the cancer, so researchers said this is where supplemental screening tools can help.

Of note from the study, although more cancers were detected (adding ultrasound led to 242 patients undergoing biopsies), only 7.4 percent of these women ended up having cancer.

Federal guidelines currently suggest that women older than 50 receive a mammogram once every two years. But those guidelines clash with recommendations from the American College of Obstetrics and Gynecology, and the American Cancer Society. Both organizations recommend women begin getting annual mammograms at age 40.

The new research comes on the heels of a Norwegian study published Sunday in the Archives of Internal Medicine, which found that women who underwent regular mammogram screenings had an estimated 15 percent to 25 percent of breast cancers diagnosed, but raised the question as to whether the tumors might actually vanish without treatment.

Overdiagnosing and false-positives have long been part of the debate about breast cancer screenings, but Berg said most overdiagnosing occurs in women who have ductal carcinoma in situ, a cancer that hasn't spread past the milk ducts and is usually less severe than other forms of the disease.

"Oftentimes, DCIS will never come to matter in a woman's lifetime, but we didn't look at that," said Berg. "For these invasive cancers, it's hard to argue that they're not important because those are the ones more likely to spread and matter."

"The fundamental problem is that we have no evidence that detecting these cancers by ultrasound actually saves lives," said Dr. Daniel B. Kopans, a professor of radiology at Harvard Medical School. "With all the effort that has gone into ultrasound screening over the last decade, it is surprising that no one has done a randomized, controlled trial, which is the only way to know if finding these cancers actually saves lives."

Copyright 2012 ABC News Radio







ABC News Radio