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Putting Medical Tests to the Test

UCLA Health
Dr. James Davis

Much of the excess cost and waste in health care can be attributed to unnecessary tests and procedures. By some estimates, as much as 30 percent of all health care spending is considered wasteful.

Patients play a role in this process by requesting tests and procedures they have heard or read about or because their friends had one. Doctors often find it difficult to resist these requests and may be driven to order tests out of fear of being sued – the practice of defensive medicine.

Inappropriate testing is not only wasteful but also can lead to harm when false-positive results lead to further testing and procedures that carry risk. For example, a benign-looking finding on a chest X-ray can lead to additional radiation exposure or invasive procedures that sometimes cause complications.

This month, the American Board of Internal Medicine and nine subspecialty groups published a list of 45 commonly used procedures that should be re-evaluated by physicians and patients because there is little or no evidence to support their use and some evidence of potential harm. Examples include cardiac-stress tests in patients without symptoms and pre-operative chest X-rays in patients without histories of lung problems.

Other examples include brain imaging for common headache and X-rays for general low-back pain. These lists are meant to publicize the problem of excessive testing and serve as guidelines for patients and physicians. Individual circumstances should determine which tests are really indicated.

When you see your doctor, remember that when it comes to testing, more is not better. There are risks associated with unnecessary testing. The results of any test should have the potential to improve your care and subsequent health, and test results obtained by subspecialists should be routinely shared with your primary physician to limit duplication and wasteful spending.

There are very few “routine tests.” EKGs, chest X-rays and most laboratory tests are not useful for prevention or health maintenance. Tests and procedures should be done with specific goals in mind and when the benefits outweigh the risks involved.

Things to remember

Work with your doctor to make sure any tests being ordered are supported by evidence-based recommendations. Careful attention to appropriate use of medical tests and procedures will help us get more “bang for the buck” from our health care dollars and promote better health in the bargain.

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