Do you really need those medical tests?

Common tests

The list below contains 4 screening tests that are commonly performed on orthopedic patients. These are tests or procedures whose necessity should be questioned and discussed thoroughly with your doctor before proceeding.

If your doctor recommends that you get one of the tests below, ask some questions to help you weigh the risks and benefits. I offer some suggested questions. Instead of asking “Doc, is that really necessary?” ask instead, “How would the results of this test change the management of my case, Doc?” or “Can we get this information by history and physical examination only?” and perhaps the most versatile question of all, “Can this wait for a while or should it be done ASAP?”

1. X-rays

Some doctors, especially non-orthopedic surgeons, order x-rays left and right, as long as the chief complaint is pain. Not all orthopedic patients need x-rays. There are cases when whether we see specific findings in the x-rays or not, the management won’t change. It may, however, help us rule out or exclude other causes of the pain. Remember that x-rays will mainly show us bone abnormalities. And a thorough history and physical examination usually can get the diagnosis correct, without the need for x-rays.

2. MRI  

A lot of patients or doctors insist on getting MRI if their clinical diagnosis is slipped disc. But it is necessary to remind everyone that if you perhaps do an MRI on all people in the world, 20% might show slipped disc in the MRI, even if they have no symptoms. Unless you are planning to undergo surgery, MRI is usually not needed for diagnosis.

3. Uric acid test

A lot of patients come to orthopedic surgeons with uric acid results already, most of the time with normal results. Apparently, this has been ordered by their primary physician beforehand. If the clinical suspicion is not gout, it is unnecessary.

4. Peripheral bone-density scans for low-risk women 

A lot of osteoporosis screening tests are just a pitch for leading anti-osteoporosis drugs, and orthopedic doctors wanting to get more patients. If this is offered free, then you may want to undergo. But unless a woman has risk factors for osteoporosis, women shouldn’t get a baseline bone density test until at least age 65. (Risk factors for osteoporosis include having a family history or previous history of fractures, small bone structure, early surgical menopause, etc.) Too often, however, women without any risk factors get this test. Many are then diagnosed with osteopenia, a diagnosis that refers to low bone density. This condition may never develop into osteoporosis, but women with the diagnosis can find themselves undergoing a lifelong regimen of costly drugs that carry side effects, from gastro-intestinal distress to the rare jawbone problem or even “atypical” thigh fractures.

Women who are found to have osteopenia but don’t want to take medications, can talk to their doctors about taking calcium supplements and doing more weight-bearing exercise.

Summary

Deciding when to do a procedure or screening test can involve as much art as science, because behind those illnesses and scientific evidences are real patients with real feelings and demands. There are few hard and fast rules, and medicine is not an exact science. Much of the necessity of the tests depends on the risk profile of the patient. Doctors and patients should work together to find the right balance. Otherwise, there’s no end to the tests we can do, the harm we can cause, and the money we can spend. 

The tendency to over-diagnose and over-treat is often a result of doing unnecessary tests. Giving financial incentives to doctors to deliver more efficient and cost-effective care, is probably a step in the right direction.

What do you think? - Rappler.com

Dr Geraldo “Raldy” Herrera is a board-certified orthopedic surgeon and Fellow of the Philippine Orthopedic Association. He went to the University of the Philippines-Philippine General Hospital for medical school. He underwent residency training in Orthopedic surgery and traumatology at the Philippine Orthopedic Center. He underwent subspecialty training in the field of joint reconstruction of the hip and knee at the Philippine Orthopedic Institute and further training in Adelaide, South Australia as an International Fellow. He maintains a Facebook page, Pinoy Bone and Joint. You may also follow his blogs on http://www.pinoyboneandjoint.blogspot.com/