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Spokane, Washington  Est. May 19, 1883

Dr. Zorba Paster: Weigh pros, cons of medical tests

Dr. Zorba Paster

Can we doctors overtest? You bet we can. Is there a downside to overtesting? Of course there is. Can you, a patient, possibly know if a test is good for you or not? Yes, you can.

Health care statistics show we could save billions of dollars by smart testing. So why aren’t doctors doing this? Because we’ve been trained to think more testing is better patient care. And because you, dear patient, usually want that test.

A good example of overtesting is an MRI scan for back pain that has lasted less than six weeks. This $2,000 test is rarely needed acutely. There are exceptions. An MRI is appropriate for loss of bowel and bladder function, intractable pain that is not relieved with appropriate doses of narcotics, or if there are suspicions of spine cancer.

Most people with back pain do well with chiropractic manipulation, anti-inflammatories, stretching exercises and time. An MRI doesn’t add much. If you’re considering surgery, then yes; otherwise, no.

Another example of a bad test is the Prostate Specific Antigen, the PSA test for prostate cancer. Case in point: A doctor friend of mine in California had a patient who came into his office for a preoperative exam. This 75-year-old guy defined optimal health — he ran a successful restaurant, was an active church volunteer, golfed three days a week and made love to his wife of 50 years all the time.

Every year he went to his urologist to have his PSA tested because six years previously his PSA was elevated. An elevated PSA might mean you have prostate cancer, so he was worried. For five years, his urologist took a prostate biopsy, which turned up negative. Last year, it turned up positive and the doctor recommended removing the prostate.

When my internist friend saw the patient to clear him for his surgery, she was confused. She asked him why he was having it done and told the patient there was no concrete evidence that removing the prostate would lengthen his life. The patient might not be as likely to die from prostate cancer, but he would be just as likely to die from another cause. Was this surgery worth it?

The patient replied, “I’m having it out.”

Long story short – surgery went well. The prostate indeed had a pea-sized lump of cancer. The patient was so relieved until two weeks later, when he suffered a blood clot to his lung and nearly died from that. He pulled through, but today he is stuck with the dribbling issues and erectile dysfunction that are common complications of prostate surgery.

I can’t help but wonder if he would make the same decision today.

There are lots of tests that are good – Pap tests, cholesterol tests, blood-pressure checks, tests for diabetes. Some are done too often, and some are done too infrequently. If you follow the Federal Preventive Services Guidelines, you’ll get what you need and nothing else. I call that smart testing.

The three questions to ask your doctor are: 1) Is this test necessary to make the diagnosis? 2) Will this test alter my treatment? 3) Will the treatment result in a longer, sweeter life. Then you make the call.

My spin: Testing has a place; overtesting does not. Ask your doctor my three questions and you’ll have a robust conversation that will give you better care.

Dr. Zorba Paster is a family physician, professor at University of Wisconsin School of Medicine and Public Health, and host of the public radio program “Zorba Paster on Your Health,” which airs at noon Wednesdays on 91.1 FM, and noon Sundays on 91.9 FM. His column will appear twice a month in The Spokesman-Review.