Try an apple a day, not an annual exam

In Dispatch, we frequently cover the latest findings on screenings for a variety of health conditions. Annual EKG's, Pap smears, and prostate specific antigen (PSA) tests have all come under scrutiny within the past year, with the latest research advising far fewer of them. More often than not, that research shows that screening too often is not only unnecessary, but also costly and potentially even harmful. Still, as Elisabeth Rosenthal observes in The New York Times, "the last decade has seen a boom in what hospitals and health care companies call 'executive physicals' batteries of screening exams for apparently healthy people."

The reasons for this excess of screening exams and medical procedures are many, ranging from America's abundance of specialists to physicians malpractice fears, as well as just plain habit (and of course, such screening is often a money-maker for hospitals offering these packages). However, Rosenthal's overview of the issue was spurred by a recent initiative called Choosing Wisely, led by the American Board of Internal Medicine Foundation, which has compiled a list of basic medical tests and procedures that are routinely performed without any need.

ACSH's Dr. Gilbert Ross agrees in principle with the change in screening philosophy, given the lack of outcome benefits for most of these tests. However, the specter of defensive medicine is the unseen force behind many of the tests ordered, he notes. It s easy for some ivory tower group to condemn unnecessary tests, but similar to the directive to avoid excessive salt, necessity can be a gray area and is too often based on avoiding a lawsuit rather than helping the doctor with a diagnosis. And such guidelines, he admits, can easily slip into stringent cost containment, sometimes known as rationing.

We recommend the entire article, but if you only have time for the accompanying graphic, take a look at its sampling of the tests and procedures that recent research suggests you're better off avoiding.