The Don’t-Do List: 4 Treatments and Tests to Reconsider
What doctors do is important. Equally important: what they don’t do.
What doctors do is important. Equally important: what they don’t do. To keep patients healthier, prevent unnecessary treatment (and side effects), and save health-care dollars, a panel of doctors is urging internists, family medicine specialists, and pediatricians to follow top-five lists of medical don’ts. Here are some of those tests and procedures — and the go-slow approaches that are preferable.
- Don’t do an imaging test within the first six weeks except in special cases.
“The vast majority of back pain goes away on its own,” says Shannon Brownlee, author of Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer. “A back image is not going to help you heal faster, but it can mislead your doctor into thinking that something is wrong, which can lead to costly and unnecessary surgery.” Of course, sometimes tests and treatments are unavoidable (say, if you’re also having bladder problems), so make sure your doctor listens carefully to all your symptoms, says Jerome Groopman, MD, coauthor of the forthcoming Your Medical Mind: How to Decide What Is Right for You. “A really good doctor doesn’t follow a cookbook,” Dr. Groopman says.
- Don’t do a routine bone-density test for women under 65 or men under 70.
The standard test, dual-energy X-ray absorptiometry (DEXA), measures the mineral content of your bones, but “for premenopausal women, routine screening is a huge scam,” says Brownlee. “It often leads them to take osteoporosis drugs, which is very controversial at best for that age group. At that age, you don’t need a DEXA scan to tell you what you should be doing to prevent osteoporosis.”
Electrocardiogram (ECG) Screening
- Don’t do an annual test if risk is low.
“If you don’t have symptoms and are at low risk for heart disease, chances are pretty good that the test is wrong if it says you do have a problem,” Brownlee says. Even so, your doctor will almost certainly feel compelled to follow up with more invasive tests that carry the risk of injury or even death.
- Don’t give antibiotics for most cases of mild or moderate sinusitis.
“Antibiotics are not ‘anti-every-kind-of-bug’ drugs,” Brownlee says. “They don’t work against viruses, and most sinus infections are caused by viruses.” Plus, overprescribing these drugs can produce stubborn new bacterial strains that antibiotics can’t fight — which can cause problems more serious than sinus trouble. Don’t ask for the hard stuff unless the sinus problem is severe or symptoms last longer than a week or get better and then worsen.