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From Yahoo! SHE Philippines : Doctor’s tests (and meds) you don’t need

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By Dr. Diana Sarmiento, The Blogging Doc | Yahoo! SHE – Thu, Apr 26, 2012 3:12 PM PHT

With the cost of gasoline and basic commodities skyrocketing, what's to stop the medical care system from increasing their rates too?

However, higher doctor’s fees shouldn’t mean putting your health at risk by skipping your regular check-up in a bid to save money.

Instead, the answer may lie in foregoing diagnostic tests that are unlikely to aid in the treatment of your condition.

Some tests can cause harm
In the U.S., an initiative called Choosing Wisely has been launched by an American medical foundation to encourage doctors and patients “to think and talk about medical tests and procedures that may be unnecessary, and in some instances can cause harm.”

It also encourages physicians to use evidence-based medicine in treating their patients.

Heeding the call are nine medical societies which compiled their list of "Five Things Physicians and Patients Should Question" in an effort to make the patient avoid unnecessary and very often, costly, diagnostic tests.

For example, radiologists have been cautioned to avoid routine x-rays for patients checking into hospitals with a normal or “unremarkable” history and physical exam.

Overuse of CT scans and antibiotics

Also common among other groups like oncologists, family physicians and cardiologists and others are warnings against the overuse of CT scans and antibiotics.

Often, doctors choose to "over" prescribe lab tests for fear of missing out on a serious disease that the patient might have and avoiding the prospect of being sued for malpractice.

Evidence-based medicine, backed by several, large population studies, is the answer. 

Decisions and choices that are supported by academicians and researchers who are the authorities in their field of specialty will give both the doctor and the patient peace of mind that they are taking the right course of action.

5 things to question
To find out the "Five Things Physicians and Patients Should Question" from nine medical societies, click on the following links:
American Academy of Allergy, Asthma & Immunology
American Academy of Family Physicians
American College of Cardiology
American College of Physicians
American College of Radiology
American Gastroenterological Association
American Society of Clinical Oncology
American Society of Nephrology
American Society of Nuclear Cardiology

Sample from American Academy of Allergy, Asthma & Immunology:

Five Things Physicians and Patients Should Question
1.  Don’t perform unproven diagnostic tests, such as immunoglobulin G (IgG) testing or an indiscriminate battery of immunoglobulin E (IgE) tests, in the evaluation of allergy.

Appropriate diagnosis and treatment of allergies requires specific IgE testing (either skin or blood tests) based on the patient’s clinical history.  The use of other tests or methods to diagnose allergies is unproven and can lead to inappropriate diagnosis and treatment. Appropriate diagnosis and treatment is both cost effective and essential for optimal patient care.

2.  Don’t order sinus computed tomography (CT) or indiscriminately prescribe antibiotics for uncomplicated acute rhinosinusitis.

Viral infections cause the majority of acute rhinosinusitis and only 0.5 percent to 2 percent progress to bacterial infections. Most acute rhinosinusitis resolves without treatment in two weeks. Uncomplicated acute rhinosinusitis is generally diagnosed clinically and does not require a sinus CT scan or other imaging. Antibiotics are not recommended for patients with uncomplicated acute rhinosinusitis who have mild illness 
and assurance of follow-up. If a decision is made to treat, amoxicillin should be first-line antibiotic treatment for most acute rhinosinsutis.

3.  Don’t routinely do diagnostic testing in patients with chronic urticaria.

In the overwhelming majority of patients with chronic urticaria, a definite etiology is not identified. Limited laboratory testing may be warranted to exclude underlying causes. Targeted laboratory testing based on clinical suspicion is appropriate. Routine extensive testing is neither cost effective nor associated with improved clinical outcomes. Skin or serum-specific IgE testing for inhalants or foods is not indicated, unless there is a clear history implicating an allergen as a provoking or perpetuating factor for urticaria.

4.  Don’t recommend replacement immunoglobulin therapy for recurrent infections unless impaired antibody responses to vaccines are demonstrated. 

Immunoglobulin (gammaglobulin) replacement is expensive and does not improve outcomes unless there is impairment of antigen-specific IgG antibody responses to vaccine immunizations or natural infections. Low levels of immunoglobulins (isotypes or subclasses), without impaired antigen-specific IgG antibody responses, do not indicate a need for immunoglobulin replacement therapy. Exceptions include IgG levels <150mg/dl and genetically defined/suspected disorders. Measurement of IgG subclasses is not routinely useful in determining the need for immunoglobulin therapy. Selective IgA deficiency is not an indication for administration of immunoglobulin.

5.  Don’t diagnose or manage asthma without spirometry. 

Clinicians often rely solely upon symptoms when diagnosing and managing asthma, but these symptoms may be misleading and be from alternate causes. Therefore spirometry is essential to confirm the diagnosis in those patients who can perform this procedure. Recent guidelines highlight spirometry’s value in stratifying disease severity and monitoring control. History and physical exam alone may over- or under-estimate asthma control. Beyond the increased costs of care, repercussions of misdiagnosing asthma include delaying a correct diagnosis and treatment.  

Read more from the author:
Evening exposure to a virus can make you more sick 
How a bicycle handlebar affects the female orgasm 
How to prevent illness from ruining your vacation 

Have a medical question for the Blogging Doc? Drop her a line at

Dr. Diana Sarmiento is a mother of three, part-time doctor, and a full-time wife and mother. The topics closest to her heart are women’s health, parenting, and any new information that she can get her hands on.