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Why Doctors Push Diagnostic Tests You Don’t Need

I wish I had a dol­lar for each patient I’ve spared from an unneeded MRI, CAT scan, X-ray, or other diag­nos­tic test.

Though occa­sion­ally one of these tests is needed, my local radi­ol­ogy lab would go broke if they were count­ing on me for referrals.

Still, that doesn’t mean I like shoot­ing in the dark and tak­ing undue risks with my patients’ health.  For­tu­nately, I have three diag­nos­tic meth­ods to rely on.

The first is the con­sul­ta­tion, where the patient tells the doc­tor what’s going on.  If you lis­ten dur­ing the con­sul­ta­tion you can piece together a lot.

The sec­ond is the good old-fashioned phys­i­cal exam­i­na­tion.  That’s when I get my hands on you, check­ing your painful spots and eval­u­at­ing your joints, mus­cles and posture.

But the third diag­nos­tic method is the most impor­tant — a trial of ther­apy.  With this diag­nos­tic tool, you start a rea­son­able plan of action and then closely mon­i­tor the results you get, mod­i­fy­ing along the way as needed.

If you have a treat­ment method with a very (very) low risk of neg­a­tive effects (and chi­ro­prac­tic man­ual ther­apy, one of the safest treat­ments around, is in this cat­e­gory) the best diag­nos­tic test is often a trial of therapy.

That’s because you get dou­ble the bang for your buck.  While you’re deter­min­ing whether or not a par­tic­u­lar treat­ment approach can help you get bet­ter, you’re actu­ally – tada! get­ting better.

By con­trast, new research con­tin­ues to emerge to show that there’s rarely much to gain in tak­ing MRIs when you have back pain.

That’s an area I’m very famil­iar with.  But recent research also debunks

So why has there been such a surge in expen­sive diag­nos­tic tests over the past decades?

To under­stand the phe­nom­e­non, let’s go way, way back.

To 1986.

To an arti­cle in the Cana­dian Med­ical Asso­ci­a­tion Jour­nal titled “A frame­work for clin­i­cal eval­u­a­tion of diag­nos­tic tech­nolo­gies.”

The arti­cle makes the impor­tant dis­tinc­tion between a diag­nos­tic test being accu­rate ver­sus a test pro­vid­ing some ben­e­fit.

Accu­rate is impor­tant, to be sure.  But use­ful is more impor­tant.   After all, you don’t need to launch a weather bal­loon to mea­sure the baro­met­ric pres­sure in the upper atmos­phere to two dec­i­mal places if all you want to know is whether to put on a sweater when you go out.

The authors (Guy­att, Tug­well, Feeny, Haynes, and Drum­mond, for those keep­ing score at home) spec­u­late as to why doc­tors grav­i­tate to cer­tain tech­nolo­gies even if their ben­e­fits are questionable.

Here are some excerpts:

Diag­nos­tic tech­nolo­gies have not been ade­quately assessed to deter­mine whether their appli­ca­tion improves health.

We believe the stan­dards for eval­u­at­ing new tech­niques have not been suf­fi­ciently rig­or­ous and that inad­e­quate eval­u­a­tion has led to overuti­liza­tion of diag­nos­tic techniques.

Accu­rate diag­nos­tic tests may influ­ence nei­ther ther­apy nor patient out­come, and yet may still receive whole­hearted sup­port from the med­ical community.

This may be because physi­cians and policy-makers are con­vinced of [their] ben­e­fit even in the absence of ade­quate data, because they see the demon­stra­tion of accu­racy as suf­fi­cient rea­son for dis­sem­i­na­tion [of a tech­nol­ogy] irre­spec­tive of ben­e­fit, or because the CT scans abil­ity to reduce the physician’s anx­i­ety and increase his or her con­fi­dence may favor rapid dif­fu­sion and offi­cial endorsement.

Although one may think of more sin­is­ter pos­si­bil­i­ties (such as the increased power and sta­tus, and the finan­cial advan­tages, acquired by the med­ical pro­fes­sion as it adopts more and more mys­te­ri­ous and appar­ently pow­er­ful gad­getry, or the unreg­u­lated pro­mo­tional efforts of the com­pa­nies respon­si­ble for devel­op­ing the new tech­nol­ogy) we sus­pect that the third expla­na­tion may be the most important.”

Unfor­tu­nately, since 1986, lit­tle has changed for the better.

Let me para­phrase their con­clu­sion for you:

Doc­tors overuse sophis­ti­cated diag­nos­tic tech­nol­ogy, even when it hasn’t been shown to be ben­e­fi­cial, because it reduces physi­cian anx­i­ety and increases physi­cian con­fi­dence.

Despite the bril­liant sci­en­tific advances of the past decades, doc­tors are aware of how super­fi­cial our knowl­edge of health still is.  Under these cir­cum­stances, it’s stress­ful to take respon­si­bil­ity for patients’ well-being.  And to be effec­tive prac­ti­tion­ers, doc­tors have to find a way to con­trol their stress.

The illu­sory cer­tainty of high-tech diag­no­sis is one antidote.

Do doc­tors of chi­ro­prac­tic deal with their anx­i­ety differently?

Doc­tors of chi­ro­prac­tic have the same stress in regard to their respon­si­bil­i­ties as physi­cians as allo­pathic doc­tors do.  And chi­ro­prac­tors also reduce their anx­i­ety, in part, by over-relying on tests.

But there is a fun­da­men­tal difference.

Unlike the allo­pathic model of med­i­cine, the cen­tral focus of chi­ro­prac­tic is the unshake­able knowl­edge that the forces that con­trol and reg­u­late our bod­ies, although still largely unex­plained by cur­rent sci­ence, shape our health for the good.

We’re designed to be healthy auto­mat­i­cally – to fight off infec­tion, heal injured tis­sues, opti­mally reg­u­late our hor­mones, learn new move­ment skills, adapt to dis­abil­i­ties as they arise, make opti­mal use of absorbed nutri­ents, and much more.

Rather than fear the unknown, and paper over the gaps in our sci­en­tific knowl­edge, doc­tors of chi­ro­prac­tic are trained to expect health from their patients.

Being steeped in this aspect of sci­en­tific real­ity gives doc­tors of chi­ro­prac­tic a nat­ural immu­nity from anx­i­ety and an in-born con­fi­dence in the health poten­tial of our patients.

That’s the designed-by-nature bot­tom line.
 
 
 


2 Responses to “Why Doctors Push Diagnostic Tests You Don’t Need”

  1. George Blomme says:

    If you have enough pain and the doc­tor sug­gests a MRI or other scan, it can be a big assist for the doc­tor to assess how bad the phys­i­cal makeup of the back is. Is the back totally dete­ri­o­rated? Is the back imping­ing on nerves,and where? Only a MRI will give you this info, and it saves time for the patient when you go from spe­cial­ist to spe­cial­ist seek­ing relief for back pain. The doc­tor looks at the MRI results and from that can he/she/they can tell what kind of phys­i­cal shape your back is in. There’s sim­ply no other way to ascer­tain that.

    • Thanks for your response, George. I don’t strictly dis­agree with what you’re say­ing, but I do feel your remarks some­what miss the point. The point is that the infor­ma­tion about your back’s func­tional abil­ity is as mean­ing­ful, or more mean­ing­ful, than what shows up on the MRI. The doc­tors who are enthralled by the MRI would have you think that what shows up on the scan con­sti­tutes the “phys­i­cal shape your back is in”. But that isn’t true. The level of pain a per­son is in and the level of phys­i­cal dis­abil­ity a per­son has are sig­nif­i­cant mea­sures of an individual’s prob­lem, but they do not cor­re­late with the sever­ity of MRI find­ings. If you’re try­ing to make sense out of back pain, there are far more impor­tant indi­ca­tors to pay atten­tion to than the MRI.

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