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When to Say ‘Whoa!’ to Your Doctor

Mar 18, 2014 01:45PM, Published by Arden Haley, Categories: Health, Today




Doctors often order tests and recommend drugs or procedures when they shouldn’t—sometimes even when they know they shouldn’t. In fact, nearly half of primary-care physicians say their own patients get too much medical care, according to a survey published in 2011 by researchers at Dartmouth College. And the Congressional Budget Office says that up to 30 percent of the health care in the U.S. is unnecessary.

All that unneeded care can be hazardous to your health—and your wallet. For example, X-rays and CT scans expose you to potentially cancer-causing radiation, and can lead to follow-up tests and treatment with additional risks. And the costs can be substantial. A 2011 study found that the price tag for 12 commonly overused tests, such as annual electrocardiograms (EKGs) for heart disease and imaging tests for lower-back pain, was about $6.8 billion.

The problem has become so serious that such groups as the American College of Physicians, the National Physicians Alliance, and a coalition of medical societies in a project called Choosing Wisely have compiled lists of tests and treatment doctors themselves say are done too often. Below are the top five examples culled from those lists:

1. EKGs and exercise stress tests for heart disease

The problem: For many people, an EKG—which records the heart’s electrical activity through electrodes attached to the chest—is a standard part of a routine exam. Some also regularly get an exercise stress test, which is an EKG done as they walk on a treadmill. Both are key if you have symptoms of heart disease or are at high risk of it. But for other people, the tests are not as accurate and can lead to unnecessary follow-up and treatment.

The risks: Those follow-up tests can include CT angiograms, which expose you to a radiation dose equal to 600 to 800 chest X-rays, and coronary angiography, which exposes you to further radiation. Inappropriate testing can also lead to overtreatment with drugs or even surgery.

The costs: An EKG typically costs about $50 and an exercise stress test about $200 to $300, according to the HealthCareBlueBook.com. Subsequent interventions that are prompted by unneeded tests can add thousands to the tab.

When to consider the tests: An EKG and exercise stress test should often be ordered if you have chest pain, an irregular heartbeat, or other symptoms of heart disease. They can also make sense for people with diabetes or other coronary risk factors who are just starting to exercise.

2. Imaging tests for lower-back pain

The problem: Getting an X-ray, CT scan, or MRI can seem like a good idea. But back pain usually subsides in about a month, with or without testing. Back-pain sufferers in a 2010 study who had an MRI within the first month didn’t recover any faster than those who didn’t have the test—but were eight times as likely to have surgery, and had a five-fold increase in medical costs.

The risks: One study projected 1,200 new cancer cases based on the 2.2 million CT scans done for lower-back pain in the U.S. in 2007. CT scans and X-rays of the lower back are especially worrisome for men and women of childbearing age, because they can expose testicles and ovaries to substantial radiation. Finally, the tests often reveal abnormalities that are unrelated to the pain but can prompt needless worry and lead to unnecessary follow-up tests and treatment, sometimes including even surgery.

The costs: An X-ray of the lower back typically ranges from about $200 to $285, an MRI from $875 to $1,225, and a CT scan from $1,080 to $1,520. Imaging accounts for a big chunk of the billions Americans spend for lower-back pain each year.

When to consider the tests: They often make sense if you have nerve damage, or signs of a serious underlying condition. Red flags can include a history of cancer, unexplained weight loss, recent infection, loss of bowel control, urinary retention, or loss of leg strength.

3. CT scans and MRIs for headaches

The problem: Many people want a CT scan or MRI to see if their headache is caused by a brain tumor or other serious illness. And doctors often comply to provide reassurance and to avoid lawsuits. But all that’s usually needed is a careful medical history and neurological exam. Adding a CT scan or MRI rarely helps.

The risks: Brain scans can reveal things that appear worrisome but aren’t. For example, doctors might mistake a twist in a blood vessel for an aneurysm. Those findings can trigger follow-up tests, and prompt referrals to specialists for expensive consultations. And CT scans of the head can deliver a radiation dose that’s the equivalent of 15 to 300 chest X-rays.

The costs: A standard brain CT scan costs about $340, and a brain MRI about $660. Referrals to a specialist or subsequent treatment is extra, of course.

When to consider the tests: They’re often warranted if you have an abnormal result on a neurological exam, or if your doctor can’t diagnose the problem based on your symptoms and medical exam. See a doctor if you have head pain that is sudden or explosive; different from headaches you’ve had in the past; brought on by exertion; or accompanied by fever, a seizure, vomiting, loss of coordination, or a change in vision, speech, or alertness.

4. Bone-density scans for low-risk women

The problem: Many women are routinely screened for weak bones with an imaging test called a DEXA scan. If it detects outright osteoporosis, the results can help you and your doctor decide how to treat the problem. But many people learn they have only mild bone loss, a condition known as osteopenia, and for them the risk of fracture is often quite low.

The risks: A diagnosis of osteopenia often leads to treatment with such drugs as alendronate (Fosamax) and ibandronate (Boniva), which pose numerous risks. Those include thigh fractures, throat or chest pain, difficulty swallowing, heartburn, and more rarely, bone, eye, joint and muscle pain, bone loss in the jaw, and possibly, abnormal heart rhythm. But there is little evidence that people with osteopenia benefit from the drugs.

The costs: A DEXA scan costs about $132. The price for a month’s supply of generic alendronate is $38 to $70, and $125 to $148 for Fosamax, the brand-name version. People often take the drugs for years.

When to consider the test: Women should have the scan at age 65 and men at age 70. Younger women and men ages 50 to 69 should consider the test if they have risk factors such as a fracture from minor trauma, rheumatoid arthritis, low body weight, a parent who had a hip fracture, or if they have used corticosteroid drugs for a long time, or they drink excessively or smoke. Whether follow-up tests are needed depends on the results of the initial scan.

5. Antibiotics for sinusitis

The problem: People with sinusitis—congestion combined with nasal discharge and facial pain—are often prescribed antibiotics. In fact, 15 to 21 percent of all antibiotic prescriptions for adults are to treat sinusitis. But most people don’t need the drugs. That’s because the problem almost always stems from a viral infection, not a bacterial one—and antibiotics don’t work against viruses.

The risks: About one in four people who take antibiotics report side effects, such as a rash, dizziness, and stomach problems. In rare cases, the drugs can cause anaphylactic shock. Overuse of antibiotics also encourages the growth of bacteria that can’t be controlled easily with drugs. That makes you more vulnerable to antibiotic-resistant infections and undermines the usefulness of antibiotics for everyone.

The costs: Not all antibiotics are expensive, but since doctors write so many prescriptions for them, the total cost to the health-care system is substantial—at least $31 million a year.

When to consider antibiotics: Usually only if symptoms last longer than a week to 10 days or they are accompanied by a high fever or other possible signs of a bacterial infection.
_______________________________________________

When to Say “Whoa” to Your Doctor provided by Anne Arundel Medical Center

* What’s Up? does not give medical advice. This material is simply a discussion of current information, trends, and topics. Please seek the advice of a physician before making any changes to your lifestyle or routine.


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    03:00pm

    Narrated by puppet Nathan Tweak, Famous Puppet Death Scenes is a collection of twenty-two scenes ...


  • 101 Dalmatians

    12/27/2014
    04:00pm

    Based on the book by Dodie Smith; Adapted by Martha King De Silva; Lyrics and music by Joan Cushi...


  • Small Treasures

    12/27/2014
    05:00pm — 08:00pm

    717 Gallery presents “Art Treasures,” a duo show featuring small works (10x10 or smaller) by Loui...


  • Holiday Lights Helicopter Tours

    12/27/2014
    05:00pm — 08:00pm

    See the holiday decor of Baltimore, Columbia and Annapolis the way Santa sees it! We’ll overfly...


  • Lights on the Bay

    12/27/2014
    05:00pm — 10:00pm

    Anne Arundel Medical Center’s annual holiday light show, Lights on the Bay, will open to the publ...


  • Lights on the Bay

    12/27/2014
    05:00pm — 10:00pm

    “Lights on the Bay” at Sandy Point State Park provides more than 60 spectacular animated and stat...


  • The origins of The Moscow Studio resemble a Russian fairy tale. Washington artist and Corcoran ...


  • Born in Salem, Massachusetts, in 1862, Frank Weston Benson (1862-1951) was a descendant of a fami...


  • Frank Lloyd Wright: Architecture of the Interior is an exhibition exploring the design of Frank L...


  • Light Tidewater Camera Club

    12/27/2014
    05:30pm — 07:30pm

    Now in its 51st year, the Tidewater Camera Club has long been a mainstay in the art community on ...


  • 21st Annual Symphony of Lights

    12/27/2014
    06:00pm — 10:00pm

    Come enjoy a spectacular display of 70 animated and stationary light creations. It is a treasured...


  • 21st Annual Symphony of Lights

    12/27/2014
    06:00pm — 10:00pm

    Symphony of Lights is a spectacular display of 70 larger-than-life, animated and stationary light...


  • O'Malley's March

    12/27/2014
    06:30pm

    The region's favorite Celtic rockers are back for a rollicking evening of traditional and origina...


  • Walking Ghost Tours

    12/27/2014
    07:00pm

    Got Ghosts? We do...and we'll tell you all about them...who they are, where they haunt, why they'...


  • Enjoy live music at Sam's on the Waterfront.


  • JOLLY EXPRESS

    12/27/2014
    07:00pm

    HO, HO, HO! IT'S ALL ABOARD THE JOLLY EXPRESS Annapolis' favorite holiday activity makes its r...


  • Catch John Wall, Bradley Beal, and the rest of the Washington Wizards at Verizon Center.


  • One of the most enduring shows of all time, Tim Rice & Andrew Lloyd Webber's Joseph and the Amazi...


  • FAMOUS PUPPET DEATH SCENES

    12/27/2014
    08:00pm

    Narrated by puppet Nathan Tweak, Famous Puppet Death Scenes is a collection of twenty-two scenes ...


  • Holiday Cabaret

    12/27/2014
    08:00pm

    A fund-raiser for Spotlighters Theatre featuring ... Special Guest Performer to be announced! ...


  • PIPPIN

    12/27/2014
    08:00pm

    Join us… for this magical, unforgettable production the New York Times declared “Astonishing! A...


  • Deathtrap

    12/27/2014
    08:00pm

    World-famous thrilled playwright Sidney Bruhl is suffering from a chronic case of writers' block....


  • Fiddler on the Roof

    12/27/2014
    08:00pm

    Celebrate the 50th anniversary of an American classic! More than just a poor milkman, Tevye is a ...


  • Five Guys Named Moe

    12/27/2014
    08:00pm

    Need to chase the blues away? Pull up a seat at the Funky Butt Club to celebrate the fresh, feel-...


  • Five Guys Named Moe

    12/27/2014
    08:00pm — 10:00pm

    Book by Clarke Peters / Music and Lyrics by Louis Jordan / Directed by Robert O’Hara A co-produc...


  • Fiddler on the Roof

    12/27/2014
    08:00pm — 10:00pm

    Book by Joseph Stein / Music by Jerry Bock / Lyrics by Sheldon Harnick Directed by Molly Smith ...


  • Twisted History Tavern Tour

    12/27/2014
    08:00pm — 10:00pm

    Murder, mayhem, sex and scandal! And Annapolis has seen more than its fair share! Come out drinki...


  • Telesma Decade Dance 10 Year Anniversary

    12/27/2014
    08:00pm — 01:00am

    Come celebrate Telesma's 10 year anniversary and the Winter Solstice. They've got some of their f...


  • Sloe Jim Matteo Live Music

    12/27/2014
    09:00pm

    live music


  • Walking Ghost Tours

    12/27/2014
    09:00pm

    Got Ghosts? We do...and we'll tell you all about them...who they are, where they haunt, why they'...


  • Outta The Blue

    12/27/2014
    09:00pm — 01:00am

    One of Maryland's most dynamic and entertaining live acts, Outta The Blue performs classic funk, ...


  • Haunted Pub Crawl

    12/27/2014
    09:00pm — 11:00pm

    Want to go out drinking with a long dead barmaid, a "working girl" who'll fall for you, and a gho...


  • Lovely Rita

    12/27/2014
    09:30pm — 01:30am

    Ready to rock at a moment's notice...always. Description We are a 5 piece rock/dance cover ba...


  • O'Malley's March

    12/27/2014
    09:30pm

    The region's favorite Celtic rockers are back for a rollicking evening of traditional and origina...


  • Live Music @ Broadneck Grill

    12/27/2014
    10:00pm — 01:00am

    Live Music Calendar for December: Dec. 27 Delta Loco 10 pm -1am


  • 2014 Military Bowl

    12/27/2014
    01:00pm

    The Military Bowl presented by Northrop Grumman, benefiting the USO, today announced that its 201...


  • Christmas on the Potomac

    12/28/2014
    12:00am — 12:00am

    The region's must see holiday attraction is back! Walk through a classic Christmas story and see ...


  • Christmas on the Potomac

    12/28/2014
    12:00am

    Guests will step into a magical wonderland with two million twinkling lights, amazing nightly ind...


  • Rolling Individual Tryouts for 10U Travel Team Announced The Head Coach for the 10U Annapolis...


  • The 18th Annual Bay to Ocean Writers Conference will be held February 28, 2015 at Chesapeake Coll...


  • Guests are invited to kick off the holiday season with a quick trip to the North Pole as “The Pol...


  • Do you work at a restaurant or bar? Enjoy $2.50 draft and drink specials for all your hard work! ...


  • Jazz Brunch

    12/28/2014
    10:00am — 02:00pm

    Join us for Brunch every Sunday from 10 AM to 2 PM and enjoy Live Jazz from 11 AM to 2 PM


  • JAZZ BRUNCH

    12/28/2014
    10:00am — 02:00pm

    Join us for Brunch every Sunday from 10am to 2pm and enjoy Live Jazz from 11am to 2pm. Plus, our ...


  • "Fall Off"

    12/28/2014
    10:00am

    Take a picture of our sandwich board with logo and show it to Shawn/Casey to receive your discount.


  • A new hapkido school has opened in the Annapolis area. Traditional hapkido is an effective form o...


  • SUNDAYS BLOODY MARY BAR

    12/28/2014
    10:00am — 02:00pm

    Think you can make the perfect Bloody Mary? Prove it every Sunday at Rams Head! Finlandia Vod...


  • Open to the Public

    12/28/2014
    10:00am — 04:30pm

    Stuck inside with no school or work? Friends and family in town and you need a place to go? Lo...


  • Enjoy a special display located at Pottery Barn Wing. Open during mall hours.


  • B&O's Magical Holiday Express

    12/28/2014
    11:00am — 04:00pm

    Trains are magical during the holidays! There is no better place to be a child than at the B&O ...


  • ICE! Frosty the Snowman

    12/28/2014
    11:00am — 08:00pm

    Of importance is our new ICE! featuring Frosty the Snowman Experience the region's must-see...


  • Holiday Festival of Trains

    12/28/2014
    11:00am — 04:00pm

    The B&O Railroad Museum Ellicott City Station, America’s Oldest Railroad Station, brings the magi...


  • Five Guys Named Moe

    12/28/2014
    01:00pm

    Need to chase the blues away? Pull up a seat at the Funky Butt Club to celebrate the fresh, feel-...


  • NFL Specials

    12/28/2014
    01:00pm

    Join us every Sunday for NFL Game Time Specials!


  • The Baltimore Ravens take on the Cleveland Browns at M&T Bank Stadium.


  • 101 Dalmatians

    12/28/2014
    01:30pm

    Based on the book by Dodie Smith; Adapted by Martha King De Silva; Lyrics and music by Joan Cushi...


  • Deathtrap

    12/28/2014
    02:00pm

    World-famous thrilled playwright Sidney Bruhl is suffering from a chronic case of writers' block....


  • PIPPIN

    12/28/2014
    02:00pm

    Join us… for this magical, unforgettable production the New York Times declared “Astonishing! A...


  • FAMOUS PUPPET DEATH SCENES

    12/28/2014
    02:00pm

    Narrated by puppet Nathan Tweak, Famous Puppet Death Scenes is a collection of twenty-two scenes ...


  • Fiddler on the Roof

    12/28/2014
    02:00pm

    Celebrate the 50th anniversary of an American classic! More than just a poor milkman, Tevye is a ...


  • 101 Dalmatians

    12/28/2014
    04:00pm

    Based on the book by Dodie Smith; Adapted by Martha King De Silva; Lyrics and music by Joan Cushi...


  • Lights on the Bay

    12/28/2014
    05:00pm — 10:00pm

    “Lights on the Bay” at Sandy Point State Park provides more than 60 spectacular animated and stat...


  • Small Treasures

    12/28/2014
    05:00pm — 08:00pm

    717 Gallery presents “Art Treasures,” a duo show featuring small works (10x10 or smaller) by Loui...


  • Lights on the Bay

    12/28/2014
    05:00pm — 10:00pm

    Anne Arundel Medical Center’s annual holiday light show, Lights on the Bay, will open to the publ...


  • Holiday Lights Helicopter Tours

    12/28/2014
    05:00pm — 08:00pm

    See the holiday decor of Baltimore, Columbia and Annapolis the way Santa sees it! We’ll overfly...


  • Light Tidewater Camera Club

    12/28/2014
    05:30pm — 07:30pm

    Now in its 51st year, the Tidewater Camera Club has long been a mainstay in the art community on ...


  • Frank Lloyd Wright: Architecture of the Interior is an exhibition exploring the design of Frank L...


  • The origins of The Moscow Studio resemble a Russian fairy tale. Washington artist and Corcoran ...


  • Born in Salem, Massachusetts, in 1862, Frank Weston Benson (1862-1951) was a descendant of a fami...


  • Jolly Express

    12/28/2014
    06:00pm

    HO, HO, HO! IT'S ALL ABOARD THE JOLLY EXPRESS Annapolis' favorite holiday activity makes its r...


  • 21st Annual Symphony of Lights

    12/28/2014
    06:00pm — 10:00pm

    Come enjoy a spectacular display of 70 animated and stationary light creations. It is a treasured...


  • 21st Annual Symphony of Lights

    12/28/2014
    06:00pm — 10:00pm

    Symphony of Lights is a spectacular display of 70 larger-than-life, animated and stationary light...


  • Five Guys Named Moe

    12/28/2014
    06:00pm

    Need to chase the blues away? Pull up a seat at the Funky Butt Club to celebrate the fresh, feel-...


  • ReBirth Brass Band

    12/28/2014
    07:00pm

    Whether seen on HBO’s Treme or at their legendary Tuesday night gig at The Maple Leaf, Grammy-win...


  • FAMOUS PUPPET DEATH SCENES

    12/28/2014
    07:00pm

    Narrated by puppet Nathan Tweak, Famous Puppet Death Scenes is a collection of twenty-two scenes ...


  • Deathtrap

    12/28/2014
    07:00pm

    World-famous thrilled playwright Sidney Bruhl is suffering from a chronic case of writers' block....


  • PIPPIN

    12/28/2014
    07:30pm

    Join us… for this magical, unforgettable production the New York Times declared “Astonishing! A...


  • One of the most enduring shows of all time, Tim Rice & Andrew Lloyd Webber's Joseph and the Amazi...


  • Fiddler on the Roof

    12/28/2014
    07:30pm

    Celebrate the 50th anniversary of an American classic! More than just a poor milkman, Tevye is a ...


  • Have you wondered if there was SALSA in the Annapolis area?? Have you always wanted to dance sa...


  • Walking Ghost Tours

    12/28/2014
    08:00pm

    Got Ghosts? We do...and we'll tell you all about them...who they are, where they haunt, why they'...


  • Five Guys Named Moe

    12/28/2014
    08:00pm — 10:00pm

    Book by Clarke Peters / Music and Lyrics by Louis Jordan / Directed by Robert O’Hara A co-produc...


  • Fiddler on the Roof

    12/28/2014
    08:00pm — 10:00pm

    Book by Joseph Stein / Music by Jerry Bock / Lyrics by Sheldon Harnick Directed by Molly Smith ...


  • Music: Skribe

    12/28/2014
    10:00pm

    Enjoy music from Skribe every Sunday from 10 PM to 1 AM


  • Down Bar Dance Party

    12/28/2014
    10:00pm — 01:00am

    Featuring DJ Little Rock every Sunday in the Pub from 10 PM to 1 AM. Drink Specials, No Cover


  • The Washington Redskins take on the Dallas Cowboys at FedExField.


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Towne Social
Towne Social