Bad Medicine: Doctor Appointments You Should Skip
Are Doctors Overdoing It?
Jackie Lahey is a model patient. She never misses her yearly physical, gyno appointment or mammogram. "I do everything right," says Jackie, of Maplewood, New Jersey. But a few years ago, her proactive approach to her health resulted in a scare that still haunts her. At age 42, she had just gotten a mammogram and was waiting for the results, when the radiologist walked into the exam room with a grim look on her face. "She said they had found a suspicious area on my chest wall," Jackie remembers. "I asked if it was cancer, but she hedged and said they needed to do further tests."
Jackie learned that she had a tumor, which had been designated BI-RAD 5, or "highly suggestive of malignancy." (The BI-RAD system designates breast cancer risk based on mammogram findings; 1 is cancer-free and 6 is cancer). "I was a wreck," she says. "All I could think about was what my kids would do if I died."
Finally, a week and a needle biopsy later, Jackie got word that the growth was actually benign. But the saga still wasn't over: The breast cancer surgeon recommended that she have the lump removed anyway; he wanted the entire thing biopsied "just in case." Jackie scheduled the surgery, which confirmed that she did not have cancer. "I was so relieved!" she says. "But now, every time I get a mammogram, I wonder if I'll have to go through all that again."
A growing number of physician groups, public health experts and medical task forces say that stories like Jackie's illustrate a major problem with today's health care system: Americans are overscreened, which can lead to false diagnoses and needless surgical procedures. Of the nation's $2.7 trillion annual health care bill, as much as $325 billion went to unnecessary medical care, a 2009 study found. Currently, 39 physician specialty groups are calling on their member doctors to stop reflexively ordering some 200 tests or procedures, including ovarian cancer screenings and MRIs for back pain, that are routinely performed but have been found to be largely pointless. And the U.S. Preventive Services Task Force (USPSTF), an independent panel of experts that releases medical recommendations, has advised against routine mammograms for women in their forties because the risk of false-positive results is so high.
"In the last 50 years, we have developed a very prevention-oriented culture," says Carolyn Westhoff, MD, a FITNESS advisory board member and professor of obstetrics and gynecology at Columbia University Medical Center. "But we're learning that we can do many of the screening tests less often and that some of them are useful only when a person has certain symptoms."
Yet most doctors still aren't heeding that message. Many are reluctant to give up tests, for reasons ranging from the well-intentioned (they truly want to search out and treat any condition that could harm you) to the self-serving (they want to cover their butts and avoid medical malpractice suits). According to one study, 93 percent of physicians in specialties with a high risk of litigation, such as ob-gyn and orthopedic surgery, said they practice "defensive medicine," meaning they order tests and perform diagnostic procedures out of fear of being sued. And some doctors may be influenced by the fact that the more they do, the more they get paid by insurance companies. To be fair, Dr. Westhoff says, many docs are simply creatures of habit, practicing what they were trained to do.
The medical system has trained patients to follow certain rules, too. Two-thirds of adults, for instance, believe that an annual physical is a must. Turns out, it's not. "Our culture believes that early detection is always good and that more is better," Dr. Westhoff says. "But it is often worth pulling back and doing a little less."
So how can you avoid subjecting yourself to unnecessary medical exams and tests but still protect your health? Here's what every woman needs to know.
What do you think of this story? Leave a Comment.