View Full Version : Do Doctors Prescribe Too Many Tests
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
6-2-17, 6:11pm
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.
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?)
It could also be fear of a medical malpractice lawsuit if you have something and they don't diagnose it.
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.)
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
6-3-17, 10:54am
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...
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.
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."
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.
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."
Curious, Jane. Do you not get tests such as a mammogram or colonoscopy? I'm being bugged to get a mammogram as a year has passed...not sure I want to get this one...I hate exposing my body to more radiation...
I am on the light side when it comes to these tests, too. Some of it is rebelliousness, some of it is just procrastination. I've had two mammograms in my life and I've never had a colonoscopy. My reasoning is probably very fallacious, but, I'm not rushing for a mammogram because I have absolutely no history of cancer in my family. I've also read studies that say that sometimes mammograms find masses that would have worked themselves out over time. There are definitely two schools of thought on mammograms, but it's not definitive that yearly mammograms do anything for overall survival. However, the risk of mortality from breast cancer without having been screened does rise as one gets older.
As for colonoscopies, I don't eat red meat, I have no other risk factors for colon cancer, and I am simply playing the odds that nothing will come up. Again, I have zero relatives who have ever had cancer.
Curious, Jane. Do you not get tests such as a mammogram or colonoscopy? I'm being bugged to get a mammogram as a year has passed...not sure I want to get this one...I hate exposing my body to more radiation...
I get nothing. I used to get Pap smears occasionally. I suppose I might croak sooner, but I'm well on my way to a normal life span. I think everyone should follow their instincts in such matters.
I have a family history of breast cancer and go for a mammogram every other year, not every year, based on the fact that Britons go less frequently than Americans with no worse outcomes. At 50 I went for a colonoscopy and polyps were found, which makes any future test diagnostic and coming out of a deductible or coinsurance, so in 5 years I am going to insist on stool cards instead. The one test I do not ever miss is the pap smear. I feel it offers good bang for the buck with no risks from radiation, perforation of the colon, etc. But cervical cancer is slow growing so at age 70 my doctor said we will discontinue the pap test.
I ...
As for colonoscopies, I don't eat red meat, I have no other risk factors for colon cancer, and I am simply playing the odds that nothing will come up. Again, I have zero relatives who have ever had cancer.
In my family, the longest-lived of us never turned down a steak. I prefer hamburger, personally. But i eschew sugar, as a rule, for the same reason you shun beef. No relative that I know of has ever had a cancer of the digestive system.
At this point in my life, you would probably have to pay me to get some of these "preventative" tests. Last mammo was 7 years ago and I don't plan to get a colonoscopy unless I'm unconscious. Glad we all get to do what works for us.
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. .
As a 30 year Registered Nurse I wholeheartedly disagree. The general population is highly litigious. once a precedent has been set, every other provider is held to that standard, feet to the fire. Patients demand certain tests. That accumulates into a new "standard of practice" and suddenly the provider can't say "I know you have (or dont have) X". They now have to prove it either way.
Example: I had a knee injury in May 2015. We were conservative. in Sept the pain had not subsided enough so an MRI was done. It showed nothing substantial. I continue the therapy. Feb 2016 I'd had it and asked for a knee scope. My surgeon agreed that was a reasonable request at this point. I had a HUGE defect on the joint surface of the thigh bone. MRI didn't show it. But the standard of care is to do an MRI.
Several years ago a local insurance company decided to do "report cards" on surgeons for standard of care. One of the best-ever surgeons got a B because he didn't MRI enough of his patients. Well hell's bells......he refused to order more.
There's nothing wrong with asking lots of questions about why and what if.....you have every right to make an informed decision. But please DO make an informed decision not a "I've had enough tests" decision.
I know lots of people who have suffered various injuries at the hands of doctors. I know no one who has sued. Maybe all these "frivolous lawsuits" are coming from the same small group of litigants. Or maybe insurers are fanning the flames.
I know a family who sued but their daughter died and was not just injured. But I think malpractice lawsuits have been exaggerated by the right, which wants to claim that tort reform will make healthcare affordable and accessible, when the dollars involved are much too small to fix the country's healthcare insurance woes by themselves.
I know a family who sued but their daughter died and was not just injured. But I think malpractice lawsuits have been exaggerated by the right, which wants to claim that tort reform will make healthcare affordable and accessible, when the dollars involved are much too small to fix the country's healthcare insurance woes by themselves.
I forgot about the right's vendetta against trial lawyers, who apparently can be counted on to contribute to left-leaning political candidates, much like unions. Gotta bring 'em to their knees!
Just because doctors prescribe does not mean one needs to participate:-)
Just because doctors prescribe does not mean one needs to participate:-)
That is correct. Getting all the information to make an informed decision is the patient responsibility. Don't just say no. Disease caught early through prevention saves unnecessary suffering and countless lives.
HappyHiker
6-4-17, 12:41pm
Oh, I agree. I figured if the cardiologist couldn't make his diagnosis complete without yet another test, then maybe he was not a whiz at diagnosing. Actually, he did tell me my pre-mature heart beats (150/hr. out of 1000 heart beats) were not worrisome--and not uncommon. He wanted the pricey nuclear stress test to investigate possible "hardening of the arteries". Wouldn't the Echo test have given him that info already?? Anyhow, I felt adequate tests had been done -- and so I was done at that point
(when I turned down the nuclear test, he suggested a different one -- which I also nixed. I felt quite strongly at that point that I was a cash cow..and in-office tests and procedures are highly profitable. He was kind of acting like a used car salesman--"oh, that car is too expensive? Then how about this one..?"
Oh, I agree. I figured if the cardiologist couldn't make his diagnosis complete without yet another test, then maybe he was not a whiz at diagnosing. Actually, he did tell me my pre-mature heart beats (150/hr. out of 1000 heart beats) were not worrisome--and not uncommon. He wanted the pricey nuclear stress test to investigate possible "hardening of the arteries". Wouldn't the Echo test have given him that info already?? Anyhow, I felt adequate tests had been done -- and so I was done at that point
(when I turned down the nuclear test, he suggested a different one -- which I also nixed. I felt quite strongly at that point that I was a cash cow..and in-office tests and procedures are highly profitable. He was kind of acting like a used car salesman--"oh, that car is too expensive? Then how about this one..?"
I'm surprised he didn't bring in his office manager to convince you, like they do in the dealerships! :devil:
What was he going to do if your arteries were sclerosing? Soften them up with medical grade Drano? Or prescribe what I call the Geriatric Death Spiral Cocktail?
Good for you for knowing when to quit.
I'm surprised he didn't bring in his office manager to convince you, like they do in the dealerships! :devil:
What was he going to do if your arteries were sclerosing? Soften them up with medical grade Drano? Or prescribe what I call the Geriatric Death Spiral Cocktail?
Good for you for knowing when to quit.
You made me laugh, Jane. You captured the scenario precisely! After I left I thought maybe I should have offered to split the Medicare payment with him so we'd both profit. But on second thought, I really didn't want radioactive material put into my veins..who knows what side effects would come from that?
Here are some of the possible side effects as set forth by the Mayo Clinic:
Risks
By Mayo Clinic Staff
A nuclear stress test is generally safe, and complications are rare. But, as with any medical procedure, it does carry a risk of complications, including:
Allergic reaction. You could be allergic to the radioactive dye that's injected into a vein in your hand or arm during a nuclear stress test, but this is rare and reactions are usually mild.
Abnormal heart rhythms (arrhythmias). Arrhythmias brought on either by exertion or the medication used during a stress test usually go away shortly after you stop exercising or the medication wears off. Life-threatening arrhythmias are rare.
Heart attack (myocardial infarction). Although extremely rare, it's possible that a nuclear stress test could cause a heart attack.
Flushing sensation or chest pain. These symptoms can occur when you are given a medication to stress your heart if you're unable to exercise adequately. These symptoms are usually brief, but tell your doctor if they occur.
I had a nuclear stress test once. The radiologists report said something like "could be something but we couldn't see it because of her bra fastener". WHAT????? You told me to leave it on. You morons!!
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