What are some of the 45 tests and procedures we should not do?
From The Academy of Allergy, Asthma and Immunology:
- IgG and a battery of IgE and other unproven allergy skin tests.
- Antibiotics for uncomplicated sinusitis (only .5-2% are bacterial infections)
- Inhalant or food testing or extensive diagnostic tests for chronic itching/hives.
- Xrays or MRI scans for low back pain within the first 6 weeks. (unless exam points to red flags).
- Dexa bone scans in women younger than 65 or men younger than 70 with no risk factors.
- Routine EKGs in patients without symptoms.
- Pap smears on women younger than 21 or women who have had a hysterectomy for non-cancer disease.
- Annual cardiac stress tests as part of routine follow-up in patients without symptoms.
- Stent placement in the non-infarct artery of patients who are stable, even if they have a ST-segment elevation myocardial infarction (STEMI) in another artery.
- Pre-op screening chest X-rays.
- CT or MRI scans for a simple fainting spell if patient has no neurological findings on exam.
- Imaging for uncomplicated headache.
- Routine admission Chest Xray.
- Follow up imaging for small (under 1cm) ovarian cysts (common and usually benign).
- Colorectal cancer screening before 10 years after normal colonoscopy.
- PET, CT and bone scans for early prostate cancer at low risk of metastasis.
- PET, CT and bone scans for asymptomatic patients that have been treated for breast cancer for curative intent.
Some doctors do these because of habit, prior training, not keeping up with current literature, fear of litigation or patient pressure to "do everything". When esteemed specialty societies come out with lists like this, we should all take notice.
Of course it is up to the individual patient and the individual physician to determine risk factors and risk/benefit of any test. But these lists should at least stimulate the question "why" and valid reasons are necessary.