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Choose wisely to avoid unnecessary medical tests

Published On: May 16 2013 08:31:16 PM CDT   Updated On: May 16 2013 09:19:46 PM CDT
CT Scan
SPOKANE, Wash. -

We think of medicine as making us better, but in some cases it can lead to more problems. That's why there's a developing list of unnecessary medical tests and procedures created by doctors and meant to empower you.

America spends more on health care than any other developed nation, but there's no evidence that our care is any better. Consumer Reports also found that 30-percent of the health care Americans receive is completely unnecessary.

It's a few of the reasons why a group of physicians from 25 medical specialties formed the group Choosing Wisely, and created lists explaining why certain test and procedures should be questioned.

"Too often and in the time that I originally did my medical training it was 'whatever you think doc' and those days are and should be done," Family Physician Glen Stream said.

Stream is a Spokane doctor who has been practicing for 31 years. Now, he's at the forefront of the Choosing Wisely campaign which seeks to empower patients to ask their doctors more questions.

That includes questions about the work Doctor Gordon Teel does as a radiologist for Inland Imaging. His office, for years, has been working to reduce radiation exposure in patients by cutting down how and when the CT scan is used.

"We're radiating people when we do it and so radiation carries a risk, especially in younger people, of causing cancer," Teel said.

Teel says a CT scan is a superior tool to diagnose, but it carries a very real radiation risk.

"In the long term there's going to be about one to two-percent more cancer deaths because of that radiation than there otherwise would have been," Teel said.

Humans are exposed to natural radiation every day, but just one CT scan of your pelvis and abdomen doses you with double the amount of natural radiation you'd get in a year. In the past, a CT scan would be given without hesitation but now Inland Imaging is more conservative with that approach.

"We were able to pretty much eliminate the use of CT in children for diagnosing appendicitis except in very selected circumstances where it turns out to be necessary," Teel said.

Choosing Wisely suggests just that: Don't evaluate suspected appendicitis in children until after an ultrasound has been considered.

Ultrasounds come first now because they carry no radiation. Why children? Teel says radiation in children and young adults has more time to potentially cause cancer.

The same advice is given by Choosing Wisely for chest pain. Nobody wants to mess around when it comes to their heart, but a CT scan isn't always necessary.

"A 22-year-old woman with chest pain, you know, a CT scan of the chest is going to radiate both her breasts and her lungs, which are very radio-sensitive organs, and so through the Choosing Wisely campaign and also through other published literature we've come up with a better way of choosing who gets a CT scan of the chest," Teel said.

It's a new approach to health care and that's certainly the case for women. Choosing Wisely says women under 21 and over 65 don't need a pap test. The ages in between only need a pap test every three years if they've had a normal test three years in a row.

Women have been taught from a young age to get one every year but those days are gone.

“The reason is even if you've found an abnormality on their pap smear, it's most likely going to be a self-limiting thing that resolves on its own and so if you find a problem then you feel compelled to treat it when the treatment could actually be more complicated than just simply letting it run its course,” Stream said.

You can also let back pain run its course, if there was no traumatic even that caused the pain. Choosing Wisely suggests it's not necessary to do imaging for low back pain in the first six weeks.

You might also run into this suggestion from Choosing Wisely: Don't routinely prescribe antibiotics for acute mild-to-moderate sinusitis unless symptoms last for seven or more days, or symptoms worsen after initial clinical improvement.

"A typical person where it meets that mild to moderate category, in the first week it's most likely a viral infection, antibiotics are not going to be helpful," Stream said.

Antibiotics only kill bacteria, not viruses. Stream says wide use of antibiotics can also harm us in the long run.

"The more times we use antibiotics when they aren't going to be helpful the more we contribute to antibiotic resistance and then they may not work when we do need them, " Stream said.

The few suggestions listed here just scratches the surface of test, procedures and practices that are unnecessary in the eyes of the Choosing Wisely physicians. There are 130 on the list, but Doctors Stream and Teel don't want you to memorize them. Instead, they want you to know that it's okay to ask questions.

"Really the entire purpose of this is for patients to feel empowered and to be active participants in the decision making about their healthcare, " Stream said.

"I don't think it's ever safe just to assume that you're doctors are doing everything perfectly, I think medicine works best when patients take an interest in what they're doing," Teel said.

You can find the lists of unnecessary tests and procedures at the Choosing Wisely website.