Beware of Medical Tests You Don’t Need

Many health care providers today say they order more diagnostic tests than are necessary, primarily to protect themselves against possible malpractice suits. This is called "defensive medicine."

In a survey of doctors in six medical specialties at high risk for malpractice suits, 93 percent said they practiced some form of “defensive medicine,” which is defined as deviating from sound medical practice to avoid the threat of liability. This included ordering tests, making referrals or abandoning high-risk procedures. The survey results were published in in the Journal of the American Medical Association.

The medical specialties surveyed were emergency medicine, general surgery, orthopedic surgery, neurosurgery, obstetrics and gynecology, and radiology.

The study found:

• Almost 60 percent of the doctors said they often ordered more diagnostic tests than necessary. The proportion was significantly higher for emergency doctors than other specialties.

• When asked to cite their most recent defensive act, more than half of emergency physicians, orthopedic surgeons and neurosurgeons mentioned ordering an imaging procedure (CT, MRI or X-ray) that they were fairly sure might be negative. They ordered it, however, because a negative result would definitely rule out that particular condition.

Defensive medicine is part of the social cost of a medical malpractice crisis, according to the researchers who conducted the survey. The doctors in the survey reported that their malpractice insurance premiums had more than doubled from 2000 to 2003, and more than half said weren't sure the insurance they had would fully protect them if they were sued.

Another reason Americans are given possibly unnecessary medical tests is because they ask for them after reading about them in magazines or hearing about them on television, according to the survey.

Take these steps

These suggestions from the Agency for Healthcare Research and Quality can help you avoid the inconvenience and expense of unnecessary tests.

1. Keep informed. Not everyone needs every test for a condition. Just because your neighbor had a high-tech blood pressure test doesn’t mean you need anything more than the usual cuff and stethoscope. It all depends on your risk factors and family history. Before you request a test, ask your doctor if it would have a clear benefit for you.

2. Ask these questions before undergoing any test or procedure your doctor recommends:

• What’s the purpose of this test?

• Are the results likely to provide enough information to confirm or rule out my diagnosis?

• What will it cost? Is there a less expensive alternative?

• How accurate is it?

• Does it cause discomfort?

• Are there possible complications or risks?

• Does it require anesthesia or hospitalization?

• How will the information be used? Will it, for example, alter the recommended treatment?

• What will happen if I don’t have the test or procedure?

Be sure you understand the answers, and if you’re still in doubt about whether to have a risky or very expensive test, ask for a second opinion.