Do Doctors Prescribe Too Many Tests

[HappyHiker]

I must admit that I tend to avoid doctors and do my best to keep fit and healthy through diet and exercise. But some recent irregular heartbeats (no other symptoms) sent me to a cardiologist.

He did an exam, listened to my heart. Then I had an EKG, an Echo test, a stress test (the doc who did the stress test told me I was at low risk for heart disease based on my performance and the EKG read-out), and then a 24-hour Holter monitor.

Then the cardiologist went over my results and told me I had 150 irregular heartbeats out of 1000--which wasn't worrisome, he said. Then he "recommended that I have another test --a nuclear stress test. Why? To ascertain if I had hardening of the arteries.

I told him maybe in the future -- I was feeling tested out. (and I don't much like the idea of having radioactive chemicals in my veins)

When I came home, I found this nuclear stress test costs around $5000. If Medicare pays 80%, I'd be liable for the 20% of $1000.

Anyhow, this is my first experience with this kind of thing...all the tests. Is this the usual procedure these days? Test. Test. Test??

Given I have low cholesterol, good blood work, normal weight, and surely the four test results must have given the doc a lot of info, I'm wondering if I was seen as a cash cow?? What do you think?

[Teacher Terry]

At age 50 I thought I was in perfect health with normal weight lots of exercise, etc. Then I was not feeling well and had all the tests you mentioned including the one you did not do. Turns out I had a way too fast irregular heartbeat, HBP and asthma. The only good news was that I did not have hardening of the arteries. The doc said I was lucky I had not had a stroke. I would probably do the test.

[sweetana3]

We just had local MRI's of the heart for $49. A local hospital figures it keeps their equipment busy. Regular price around $300. Gave us a good picture of hardening of the arteries.

Cash Cow? Yes. (Edited to add: The cash cow is the nuclear stress test for $5000. A less expensive MRI could be a good thing if it is needed for diagnosis. Second opinion?)

[Yppej]

It could also be fear of a medical malpractice lawsuit if you have something and they don't diagnose it.

[JaneV2.0]

If you're menopausal, palpitations are the rule. A little magnesium helps. Make sure you're getting all your electrolytes. I rarely get them anymore--at least not noticeably. I avoid doctors like I avoid door-to-door salesmen. (I'd be more worried about the low cholesterol, personally.)

[Tammy]

I was raised in a rural midwestern farming area where the thought was prevalent that one goes to the healthcare system as a last resort and at end of life. There was a lot of shame about being sick, weak, or seeing a doctor.

Now I view it as preventive maintenance on a car. We go to the shop so the car lasts longer and runs efficiently.

I say yes to everything that is offered that sounds reasonable. I have yet to hear an unreasonable suggestion from my healthcare providers. Yes I am darkening the door of the healthcare facilities more often since I've suddenly become 55 years old. Don't know how that happened so fast but it did.

I have no shame. I live in an urban area far from my town of origin. I have changed many of my opinions and paradigms since age 20. I am lucky to have a good healthcare plan. I am happy to take good care of my body. I do not feel scammed nor lied to nor sold a bill of goods.

I have worked 20 years in healthcare, mostly in hospitals. I'm a nurse. I believe my judgement in this regard is solid.

[HappyHiker]

I appreciate your comments and observations. I think I've traced the palpitations to whenever I fall off my usual low-sodium (high blood pressure) wagon and have a day or two of high sodium ingestion. Those electrolyte imbalances can apparently really affect your heart rhythms.

An effort I make is to eat high mag and potassium foods...

[CathyA]

What I've noticed over the years is that very few docs trust their clinical skills......and they resort to having tests that tell them what they haven't thought about or were willing to trust their judgement with.

Some people that have good tests end up dying of something related and people who have bad tests can end up living a very long life. I think there must be a happy medium somewhere.

I've lived with tons of PVCs (premature ventricular contractions). One time, they were so frequent I went to the E.R. One very smart doc gave me I.V. magnesium and I didn't have any ectopy for 2 whole weeks. I realized then that my magnesium always needed supplemented. A blood test for magnesium levels isn't very reliable, as it's different from the intercellular levels.
I also get these irregular beats when my reflux flares up or I work leaning over too much.

I think you just have to decide for yourself what is too much testing, your symptoms, how you feel, your lifestyle, etc. I think all this testing has gotten our country into many of the situations with people not being able to afford help. Plus....at some point, we have to accept aging and death......which this culture doesn't seem to understand.

[JaneV2.0]

I have simple criteria for seeing a doctor: uncontrollable bleeding, intractable pain, broken bone, difficulty breathing. I'm convinced that less is more where medical treatment is concerned, and my criteria haven't let me down so far. Every prescription has its side effects, every test has its downside. I know easily as many people who have been harmed by doctors as have been helped--especially in this age of (endlessly and profitably) treating the symptoms instead of actually healing the underlying problem. Like Cathy, I know I'm going to die of something, and I'd prefer it wasn't "standard of care."

[Tammy]

Following closely with my asthma allergy doc for 6 years has brought my asthma into complete remission. After 20 years of daily advair and other meds, I've been off all asthma medication for one year now. To get to this wonderful outcome I had to visit that office every 1-4 weeks for five years to get allergy shots. I also had annual extensive breathing tests done.

If I only went to the doctor when I was struggling to breathe I would never have had this outcome. I would still be taking an inhaler that has extensive side effects and that costs $300 a month, and I wouldn't have good control of my asthma. There is a benefit to using our medical system for prevention, rather than just when something is broken.

I don't think people understand how much medical care has improved in the last few decades. It's no longer an end-of-life heroic effort. It really is preventative maintenance.

I think this issue is heavily clouded by the broken billing and payment system within healthcare. If prices were reasonable like in other nations, and if most of the costs were covered with good insurance, then I think a lot of people would actually see their doctors for prevention and would follow through with early testing. It's always better to treat illness early than to wait until it actually bothers a person and they go in because of pain and suffering.