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It’s not just me. Gilbert Welch says it too!

November 28, 2012

Who’s Gilbert Welch?  Never met him.  But love a quote he made in a recent NYT article.  The article URL is here. http://newoldage.blogs.nytimes.com/2012/11/28/doctors-orders-another-test/?ref=health The quote follows:

“This is the way whole cascades can start that are hard to stop,” Dr. Welch said. “The more we subject ourselves, the more likely some abnormality shows up that may require more testing, some of which has unwanted consequences.”

He’s talking about testing.  Diagonstic testing.  Dr. Welch is a senior researcher at the Dartmouth Institute for Health Policy and Clinical Practice.  I’ts not just little old me saying this.  Essentially, we already know that screening tests like colonoscopy, pap smear, and PSA testing for people over 75 is generally unnecessary and potentially harmful.  According to this article, diagnostic testing can be too.  Diagnostic testing, unlike screening, takes a symptom or problem and looks for reasons for it.  So you have a pain or fainting or chest pain or abdominal pain, and various diagnostic tests are then done to find out the problem.  So if you have chest pain, an EKG and heart enzyme testing is diagnostic.  If those are negative, you might get a stress test (exercising on a treadmill while hooked up to heart monitors) to see if the pain can be recreated or the EKG changes.  Turns out, alot of people get stress tests when there is no problem, ie, the stress test used as a screening test.  Worse, these tests get repeated on some random regular basis.

Hence Dr. Welch’s comment quoted above.  As I have said before, testing leads to more testing.  For every test your doctor says you need, please ask WHY.  Personal story: when I was 25 and a medical resident I went to a primary care doctor I had never met before for a physical.  We’ll talk about the pros/cons of physicals later.  I was young and thin back then.  She listens to my heart, hears a murmur.  She says I need an echocardiogram (an ultrasound of my heart).  I have no symptoms, never had, was an avid exerciser and worked 100 hrs/wk.  She said she would call in the referral and they would call me with a time to come in.  First of all, I’m going to drop everything and come in whenever “they” tell me to?  Second, I knew that flow murmurs in young, thin, healthy people are completely normal.  I smiled and nodded and ignorned her and her echo people.

You don’t have the benefit of this knowledge.  You do, however, have the ability to at least pester your doctor for a really good reason for doing the test.  Ask him/her specifically what they are looking for and why they think they might find it.  “Just in case” is not a good reason.  “We do this for everyone at this age” is also not a good reason.   One isolated finding in an otherwise healthy person, even an elderly one, is also not a good reason.

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