Routine checks getting second look

Body & Soul

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A man sits on an ergometer during an electrocardiogram in a doctor's surgical office in Stuttgart, Germany. Some of the nuts-and-bolts tests administered during check-ups and non-emergency visits are getting a second look. AP/Thomas Kienzle

February 4, 2012

Routine checks getting second look

By LAURAN NEERGAARD, AP Medical Writer ---- The Record Eagle Sat Feb 04, 2012, 07:14 AM EST

WASHINGTON — Recent headlines offered a fresh example of how the health care system subjects people to too many medical tests — this time research showing millions of older women don't need their bones checked for osteoporosis nearly so often.

Chances are you've heard that many expert groups say cancer screening is overused, too, from mammograms given too early or too often to prostate cancer tests that may not save lives.

It's not just cancer.

Now some of the nuts-and-bolts tests given during checkups or hospital visits are getting a second look, too — things like routine EKGs to check heart health, or chest X-rays before elective surgery.

Next under the microscope may be women's dreaded yearly pelvic exams.

The worry: If given too often, these tests can waste time and money, and sometimes even do harm if false alarms spur unneeded follow-up care.

It begs the question: Just what should be part of my doctor's visit?

If you're 65 or older, Medicare offers a list of screenings to print out and discuss during the new annual wellness visit, a benefit that began last year.

As of November, more than 1.9 million seniors had taken advantage of the free checkup.

For younger adults, figuring out what's necessary and what's overkill is tougher. Whatever your age, some major campaigns are under way to help.

They're compiling lists of tests that your doctor might be ordering more out of habit, or fear of lawsuits, than based on scientific evidence that they are really needed.

Not even physicians are immune when it comes to their own health care.

Dr. Steven Weinberger of the American College of Physicians had minor elective surgery for torn knee cartilage about a year ago.

The hospital required a pre-operative chest X-ray, an EKG to check his heart, and a full blood work-up — tests he says aren't recommended for an otherwise healthy person at low risk of complications.

Weinberger should know: He led the team that compiled that new list of overused tests.

All three examples are on it.

For now, some recent publications offer this guidance:

n No annual EKGs or other cardiac screening for low-risk patients with no heart disease symptoms. Simple blood pressure and cholesterol checks are considered far more valuable.

n Discuss how often you need a bone-density scan for osteoporosis. An initial test is recommended at 65, and Medicare pays for a repeat every two years.

n Women under 65 need that first bone scan only if they have risk factors such as smoking or prior broken bones, say the two new overtesting lists.

n Most people with low back pain for less than six weeks shouldn't get X-rays or other scans, Weinberger's group stresses.

n Even those all-important cholesterol tests seldom are needed every year, unless yours is high, according to the college of physicians. Otherwise, guidelines generally advise every five years.

n Pap smears for a routine cervical cancer check are only needed once every three years by most women.

Yes, simple tests can harm.

Cleveland Clinic cardiology chief Dr. Steven Nissen cites a 52-year-old woman who wound up with a heart transplant after another doctor ordered an unneeded cardiac scan that triggered a false alarm and further testing that in turn punctured her aorta.