Medical tests—pause, think and prescribe

Excerpt

Of the zillion ills of the corporatisation of medicine, the numero uno bane is the issue of unnecessary testing. This has been brought out, yet again, in a recent structured review in JAMA Internal Medicine [1], which examined the cascading effects of ordering unnecessary tests, the case in point, ordering electrocardiography (ECG) and X-rays for routine clearance for such basic surgeries as cataract and hernias. Every minor change in the ECG is followed up by stress imaging, and in a large number of cases, coronary angiography, which infact can even be harmful. The ‘routine’ troponins in the physicians’ outpatient clinics and in the emergency ward, and the recent fashion of sending B type Natriuretic Peptide (BNPs) in any and every case of dyspnoea, are more than an anecdotal digression. Indiscrimate coronary computed tomography (CT) scans is yet another recent addition to this malady of so-called unnecessary testing. Let alone the cost, the radiation exposure and the risk of malignancy itself must make all of us sit back and answer a very basic question, before we order a test—what is the yield expected? …