Ask your doctor if these common treatments are really necessary
by Marsha Mercer, AARP, February 22, 2013
You're facing minor surgery, and your doctor orders routine preoperation tests. Do you get them?
You're a senior with insomnia. Prescription sleeping pills are OK, right?
You see an ad for a screening to detect a potential stroke. Good idea?
Probably not, the experts say. All three are among the unnecessary or potentially harmful tests and treatments identified by 17 key medical specialty societies, which recently, in Washington, released their lists of questionable procedures as part of the Choosing Wisely campaign.
That campaign, set up by the nonprofit American Board of Internal Medicine (ABIM) Foundation, began in 2012 when nine medical societies first offered their lists of unnecessary treatments.
Consumer Reports is a partner in the Choosing Wisely campaign, and John Santa, M.D., who directs that group's health ratings, says, "We know Americans believe more health care is better, and all prevention is good." But, he stresses, "waste and overuse is a major issue — and it's frequent across all medical disciplines."
Christine K. Cassel, president and chief executive of the ABIM, says the Choosing Wisely campaign is "about the right care at the right time for the right patient."
Here are seven overused tests or treatments commonly prescribed for people age 50-plus that experts now say you probably don't need if you're healthy.
1. Recommendation: Avoid routine presurgery tests for eye and other low-risk surgeries (American Society for Clinical Pathology and American Academy of Ophthalmology).
Men and women facing elective surgery — eye, foot and cosmetic operations, as well as biopsies — routinely undergo unnecessary blood and other tests. "You need to ask: Why do I need these tests?" says Lee Hilborne, M.D., an official with the clinical pathology society. Cataract patients, for example, often get an EKG, blood work and a chest X-ray, says William Rich, M.D., of the ophthalmologists group. "They're paying for tests we don't think are necessary," he says. Average costs run $300 to $400.
Danger: Aside from the cost, a few test results come back abnormal even though the patient is fine — causing anxiety and further tests that could delay the surgery.
Exception: A patient with a severe heart condition or symptoms that could be heart-related should have a presurgery EKG.
Diabetic patients need a blood glucose test and those on diuretics should have a potassium test.
2. Recommendation: Don't take prescription sleeping pills as the first choice for insomnia (American Geriatrics Society).
Insomnia is very common in older people, but experts say seniors should avoid some widely prescribed sleeping pills, such as Restril and Ambien. Instead, talk to your doctor about other therapies, such as counseling to improve sleep patterns through lifestyle changes.
Danger: Meds called sedative-hypnotics, including benzodiazepines, double the risk of falls and hip fractures, leading to hospitalization and death in older adults, according to several large studies.
"It's not entirely clear why; it may be there's some carryover the next day," says Cathy Alessi, M.D., president-elect of the American Geriatrics Society.
Exceptions: For seniors, prescription sleeping pills (sedative-hypnotics) should be reserved for anxiety disorders or severe alcohol withdrawal after other therapies have failed.
3. Recommendation: Don't get a screening test for carotid artery disease unless you have symptoms (American Academy of Family Physicians).
Companies provide screenings for carotid artery stenosis — the narrowing of arteries that can lead to strokes — but unless you have symptoms, don't get scanned. "The scientific evidence is very clear that more people are harmed than helped by having this test, and we advise against it," says Glen Stream, M.D., board chair of the family physicians group.
Danger: Screening someone with no symptoms of carotid artery disease could lead to further tests and even surgery, which carries increased risk of stroke.
Exception: If you've had a transient ischemic attack (TIA) or ministroke, you may need a diagnostic test.
4. Recommendation: Talk to your doctor about not having a urinary catheter. If a catheter must be used, have it removed as soon as possible (Society of Hospital Medicine).
One in five hospital patients has a catheter, but about half don't need one. Sometimes they're used for incontinence or the convenience of the patient or health care staff.
"Don't get a catheter put in. But if you have to have one, get it out as quickly as you can," says John Bulger, an official with the society that represents hospital physicians. While patients hate it, wetting the bed or intermittent catheterization is far preferable to the continuous use of a catheter, he adds.
Danger: Urinary tract infections from catheters are more prevalent the longer a catheter is in place. Urinary tract infections are the most common hospital-acquired infection, and can be fatal. About 13,000 people a year die as a result of infections from catheters, a study found.
Exceptions: If you have surgery, you may need a catheter. Guidelines call for its removal the next day.
5. Recommendation: Skip the annual Pap test (American College of Obstetricians and Gynecologists and American Academy of Family Physicians).
If you're under 65, get a screening every three years. After 65, if you've had several normal Pap tests, you can stop having them.
"Pap smears annually are a waste of money," says Gerald F. Joseph, M.D., of the OB/GYN group. "In average-risk women, studies show no advantage to annual screenings over those performed at three-year intervals."
Danger: False positive results cause anxiety for patients.
Exception: If you've had cervical cancer or cervical disease, continue annual Pap smears. Cervical cancer is caused by the Human Papillomavirus (HPV), which is transmitted through sexual relations.
6. Recommendation: Don't use testosterone for erectile dysfunction (American Urological Association).
A number of TV ads and men's clinics are pushing this remedy, but most men should skip testosterone supplements if their testosterone levels are normal.
"Anecdotally, we know a lot of prescriptions are being written for testosterone for men with normal testosterone," says Daniel A. Barocas, M.D., assistant professor of urologic surgery at Vanderbilt University Medical Center. But he says the prescription doesn't work for erectile dysfunction.
Danger: Testosterone does not affect the ability to get an erection. It enhances libido or sex drive but not performance. It also reduces fertility and may make prostate cancer blossom. Prostate cancer thrives on testosterone. Gels can irritate the skin; injections can increase red blood cells.
Exception: If you have other symptoms of low testosterone, including loss of muscle mass and body hair, talk to your doctor to see if hormone testing is right for you.
7. Recommendation: Don’t order a blood test for creatinine or upper-tract imaging for patients with an enlarged prostate (American Urological Association).
Most men after age 50 have enlarged prostates, which result in urination that disturbs sleep and a weaker urine stream.
Danger: Even routine tests are not risk-free. Patients spend time and money and may get false positive readings, leading to other tests. CT scans mean radiation exposure.
Exception: Tell your doctor about blood in the urine, pain with urination or urinary retention.
The full list is available at ChoosingWisely.org.
http://www.aarp.org/health/conditions-treatments/info-02-2013/medical-procedures-to-avoid.html?cmp=NLC-WBLTR-MCTRL-070513-HT1&USEG_ID=
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