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7 tests and treatments docs say you often don’t need

Consumer Reports News: May 24, 2011 02:43 PM

The National Physicians Alliance and the Archives of Internal Medicine recently surveyed family and internal medicine doctors about medical tests and treatments that are often performed—but often unnecessary. Here are seven that made their lists, plus our take on each.

1. Imaging for low back pain within the first six weeks. The doctors said that’s generally necessary only if there are red flags, such as progressive neurological problems or serious underlying conditions, such as osteomyelitis, a bone infection. Otherwise, the tests—including X-rays, MRIs, and CT scans—just increase costs without improving results.
Our take: Our report on back pain also concluded that the tests are overused. If your doctor orders one, ask why, and how it will affect your treatment and management. Staying active through exercise, or physical or chiropractic therapy should often be tried before tests or treatment. In fact, back pain usually clears up on its own within a month or so.

2. Antibiotics for short-term sinusitis. The doctors said that most often the symptoms are caused by a viral infection that will resolve on its own. So antibiotics are generally warranted only if symptoms persist seven or more days or worsen after first getting better. But about 80 percent of the 16 million doctor visits for acute sinusitis each year result in the patient leaving the doctor’s office with a prescription for antibiotics.
Our take: Sinusitis is usually caused by a virus like the cold or flu, or hay fever, and antibiotics won’t do any good against viruses or allergies. Overuse of antibiotics can lead to dangerous bacterial resistance.

3. Electrocardiogram (EKG) low-risk patients without symptoms. Such testing is often included in routine physical exams, but there’s not much evidence that it does any good, according to the panel. However, the testing can lead to false positives and unnecessary invasive procedures.
Our take: For people with chest pain or other symptoms of heart disease a stress test with an EKG should be the first order of business. But our survey of 8,056 healthy subscribers found that many healthy people also got EKGs, as well as other heart tests, that they didn’t need. See our Ratings of heart screening tests to find out which you need and which you don’t. And see our guide to heart tests.

4. Pap tests on patients younger than 21 or in women who have recently had a total hysterectomy for benign cancer. Pap tests can reveal abnormalities that might lead to cervical cancer. But in young women and adolescents, such abnormalities usually clear up on their own, while unnecessary testing can lead to anxiety, harm, and extra costs, the doctors said.
Our take: Women who’ve had a total hysterectomy for a noncancerous problem such as fibroids, no longer need Pap smears, if the procedure also removed the cervix, as it usually does. In addition, women older than 65 who have had three or more normal smears in the last 10 years and who have not had cervical cancer could also consider skiping the Pap test.

5. Bone scans for osteoporosis in most women younger than 65 or men younger than 70. The doctors said that dual-energy x-ray absorptiometry (DEXA) scans are helpful in people younger than those cut offs only if they have risk factors for weak bones.
Our take: Many people are being unnecessarily tested and treated with drugs for osteoporosis. Risk factors that can make testing worthwhile in younger people include low weight, a previous fracture, long-term use of corticosteroids, a strong family history of fracture, excessive alcohol use, and rheumatoid arthritis. Additional risk factors can include vitamin D deficiency, thyroid or parathyroid hyperfunction, and celiac disease.

6. Complete blood tests in healthy adults. Those tests can provide information about kidney function, and information about blood sugar, cholesterol, and calcium levels, among many other things. But most people don’t need to have the complete work up unless they have risk factors.
Our take: Blood tests for cholesterol, blood sugar, and C-reactive protein (CRP) can make sense for many, but not all, people. See our Ratings of heart screening tests.

7. Brand name statins when initiating lipid-lowering drug therapy. All statins are effective in lowering the risk of death, heart attacks, and strokes when prescribed appropriately, according to the panel. But brand-name statins including atrovastatin (Lipitor) or rosuvastatin (Crestor) should be used only if generic statins don’t lower LDL cholesterol as much as desired, or if they cause unwanted side effects.
Our take: Our Best Buy Drugs report on statins came to a similar conclusion. We found generic statins are appropriate for most people, but recommend Lipitor if you've had a heart attack and your LDL is 40 percent or more above the desired level.

For more, see our reports on Screening Tests You Can Live Without, and Treatment Traps to Avoid, including 10 Overused Tests and Treatments.

The “Top 5” Lists in Primary Care [Archives of Internal Medicine]

Kevin McCarthy

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