Tuesday, May 6, 2008

Screening Blood Panels - Overused, Overtested

The Annals of Internal Medicine has reported that "frequent cholesterol measurement may be misleading." There are normal variations and fluctuations in any blood test that give erroneous information and frequent checking (even annually), when a person is stable on a cholesterol lowering drug, is pointless.

Other studies have shown that the "routine" blood tests we Internists and Family Doctors order on patients are worthless. Few diseases are discovered by a blood test if the patient doesn't have any symptoms. Yet it is almost impossible to practice medicine and be seen as credible by patients if you don't order a ton of tests. Many patients would rather have the blood test and forgo the doctor visit.

This is all backwards. Somehow we have sold the public a bill of goods. Over years, medical experts have convinced patients that we can detect early disease and save their lives if only we will "do everything" possible with screening tests. We have lots of blood panels (CBC, Chem 24, CRP, TSH, urinalysis, Lipids, ANA, RF, Thyroid panels, hair analysis, hormone levels, PSA and on and on) that we can run along with chest Xrays, bone density tests, cardiac stress tests, body scans, ultrasounds and mammograms.

Of these, the only ones that have been proven to potentially prolong life are:

  • Mammogram

  • Colon screening

  • Abdominal ultrasound in men over age 60 with a history of smoking or hypertension

What if primary care doctors stopped doing all of the expensive and worthless screening tests and used that time to sit with a patient and really work out a focused and preventative lifestyle that would improve health. With the use of technology, patients and doctors could monitor changes together. It would take time and effort for both the patient and doctor and need to be valued and compensated . We could use the expensive testing $$$ to pay the doctor, nutritionist and others on the team and there would probably be money left over.

Now that would be health reform that was meaningful.


Anonymous said...

What about a pap test and yearly breast exam, or check for ovarian cancer?

I do know a guy who had a physical whose doctor ordered a PSA test because of family history of another kind of cancer the PSA showed up posative at age forty, with no symptons. It was caught at an early stage,he was treated and is fine now living a healthy and happy life.

Emily T said...

Isn't it important to know if your cholesterol is high? What about genetic testing if a certain cancer runs in your family?

Tests may be a waste of money if you're healthy, but how does a person know that they are indeed healthy? Maybe we're brainwashed,
but I don't think I could sleep at night if the doctor only went by lack of symptoms. If they did, I would probably develop psychogenic aches and pains just to get the tests.

Toni Brayer MD said...

emilyt: You are correct. It is important to know your cholesterol level and to make the lifestyle changes to bring it under control. If Statin drugs are used as treatment, liver tests should be obtained as well as another lipid panel to optimize treatment. The study referenced in the blog showed that frequent testing after the lipid levels were stable was of no use and gave unreliable data.

Testing geared toward symptoms or diagnoses is definitely needed. It is the routine "Just check everything" in healthy people with no history of high cholesterol or diabetes or any other problem that is overdone.

Anon: Breast exams and pap tests are part of the annual physical and should be done. There is a great deal of controversy about PSA tests. I do them on men over age 40 but there is no real evidence that all men should have them. All tests should be individualized for the specific patient and their family risk factors.

Believe me, we doctors do too many blood tests but patients really like them and when they are normal (as they most often are) they give a sense of security.

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berto said...

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