Too Much Testing

Patients who receive diagnostic tests for the purpose of reassurance don’t feel less worried in either the short or long terms, according to a very large analysis of fourteen clinical trials.

When the physician believes that the probability of a disease is low, there is no additional benefit in running the tests “just to be sure.” The reassurance of a negative tests offers comfort that can last as little as a few hours – “a fleeting sense of relief” – instead of long-term assurance. Ordering more tests is not the best response to the worried well.

Testing is sometimes offered in an attempt to wrap up a problem in just one visit, responding to patients concerns about increasing office co-pays and larger deductibles. This is false economy: the analysis shows that it requires testing 16-26 patients to avoid one repeat visit, and the tests cost $250 to $500 per test, therefore the health care system is spending between $4000 and $16,000 to prevent a $100 primary care visit.

There are currently evidence-based guidelines for testing for common conditions. More testing is not better medicine. Now – if only malpractice lawyers would get on board ….