Once upon a time, further back than most of us can remember, people only went to the doctor when they were sick. Unless you were in a lot of pain or otherwise unable to go about your regular activities you left the doctor alone so he could look after the sick folks.
But things are different today. Thanks to advances in medical science we are now encouraged to go see the doctor for regular “checkups” even though we feel fine and we are often encouraged to undergo medical tests to “screen” for possible hidden problems.
Aren’t we lucky to be living in an age where doctors are actively looking for problems before they occur? Imagine how many lives have been extended and improved thanks to preventative medical screening.
No doubt there is some truth to that, but it is not quite so cut and dried. Lately, we’ve been hearing some dissenting voices within the medical community concerning the wisdom of ordering diagnostic tests for apparently healthy patients.
I am currently reading a book called “Overdiagnosed: Making People Sick in the Pursuit of Health” by Dr. H. Gilbert Welch that makes that very point, and I strongly encourage you to pick it up and read it for yourself.
The central theme of this book, which Welch drives home with numerous real world examples from his own practice, is that the medical community has used its increasingly advanced medical diagnostic capabilities to expand the number of patients it tests and treats for “abnormalities” that might well have caused patients no real problems if they’d been left alone. Even worse, there are a disturbing number of cases where this unneeded treatment is causing unnecessary harm.
One of the starkest examples of the “more harm than good” class of medical tests he cites is the PSA blood test that until recently all men were encouraged to take to screen for prostate cancer once they reached a certain age. The test is so sensitive that it detects extremely minute elevations of a chemical in the blood that can be a signal of cancerous activity within the prostate.
Welch estimates that over a million American men underwent treatment for prostate cancer based on the results of these tests that otherwise would have had no issues with their prostate during a normal life span. The treatments are expensive and can be painful and debilitating, and that doesn’t take into account the psychological toll that being a “cancer patient” takes on a person and their loved ones.
The PSA test now seems to be falling out of favor entirely with many doctors, but similar questions are being raised about other popular medical screening tests. Lately, there’s a lot of discussion over whether women really benefit overall from having preventive mammography screenings, a debate that sounds an awful lot like the PSA blood test controversy with talk of numerous false positives leading to a lot of unnecessary treatment.
As health care consumers we need to be aware of certain factors that encourage doctors to run as many tests as possible and treat any possible issue these tests find in an aggressive manner.
Medical tests are a significant source of income for doctors and hospitals and it is rare for a doctor to get sued for being overzealous in testing and treating possible illnesses, so they are likely to err on the side of overtreatment.
When it comes to your medical care, it’s up to you to look out for your own best interests. Unless you are experiencing a medical emergency that obviously requires immediate treatment, do your research and ask questions before you agree to expensive diagnostic tests and subsequent courses of treatment. Oftentimes there are trade-offs between the risk a potential problem represents and the cost and side effects of a course of treatment. Know what those trade-offs are and be an active participant in deciding what is done to your body. It is, after all, your body, and your life.
If your doctor is one that doesn’t believe in making his patient an active partner in his or her own medical care, you need to find another doctor.
Bill Ferguson is a resident of Centerville. Readers can write him at firstname.lastname@example.org or visit his blog at nscsense.blogspot.com.