Buttoo muchmedical care has its own risks.
Were not saying that you should ever turn downnecessarycare.
Thats not true, of course: its better to be alive anddealing with hospital billsthan debt-free but dead.
One good place to start is at theChoosing Wiselywebsite from theAmerican Board of Internal Medicine.
Lets look at some of the take-home messages.
Tests Have Risks and Benefits
You might think of a medical test as asking a simple question.
Questions dont sound harmful, so we (and doctors!)
often like the idea of doing a test and finding out whats wrong.
But no test is perfect, and there are consequences to a test being wrong.
Take mammograms, for example.
Each represents a slightly different judgment call onhow to balance the risks and the benefitsof this arguably overhyped test.
Some women with low cancer risks aremore likely to be harmed than helped by mammograms.
Here are some more tests that, according to the Choosing Wisely recommendations, are worth questioning.
Your doctorshouldbe on board with the most recent guidelines, but sometimes old habits die hard.
Annual pap tests to screen for cervical cancer.
Most womenshould get tested every 3 to 5 years.
Blood tests for Vitamin D.These only make sense for people with certain diseases or risk factors.
Vitamin D testsarent usually helpful for healthy people.
PSA tests for prostate cancer screening.
Blood tests can look for prostate-specific antigen (PSA) but there arefar more false positives than useful results.
These incidental findings then require more observation over the yearswhich means more scans.
Benefitsonly sometimes outweigh the risks.
Blood tests for miscarriage risk.
Mostusually arent helpfuland can lead to unnecessary treatment.
Emergency room CT scans for minor head injuries.
CTs arenot only unhelpful, theyre also expensive and expose you (or your child) to radiation.
See a rundown of useful tests and their age ranges onthis fact sheet about checkups.
Treatments Have Risks and Costs, Too
Treatments also deserve scrutiny.
Take antibiotics, for example.
Too much antibiotic use also encourages antibiotic-resistant germs, likesuper-gonorrheaandMRSA.
Not surprisingly, a lot of the Choosing Wisely guides are all about ways of avoiding antibiotics.
But there are other treatments, too, that are worth questioning.
Cancer treatment for somebody nearing the end of their life.
Its adiscussion worth having.
Surgery for plantar fasciitis.Non-surgical approachesoften work better, and the surgery carries risks of permanent damage.
Sleep studies for insomnia (but not sleep apnea)Its usually possible todiagnose and treat insomnia without one.
Sleep studiesdohelp to diagnose sleep apnea.
Too-easy physical therapy,which is often prescribed for older people out of a fear they will hurt themselves.
But if exercises arent challenging,they arent helping.
Urinary cathetersincrease the risk of a urinary tract infection, so they shouldonly be used when necessary.
Most of the time, its best toleave them alone.
For example, there are prenatal tests that can tell youwhether your fetus seems to have a genetic abnormality.
If not, its okay to say you would rather not have the test at all.
What are the benefits?
What else could we try instead?
And dont forget to askeven if youre the one who suggests the test or treatment.
but also ask about its risks and alternatives.
Same ideaif theres a testyouve heard everyone should get.
Learning about those choices and tradeoffs helps you to be a smarter, and perhaps a healthier, patient.
Illustration by Sam Woolley.
