Zorba Paster: TMI…Too Much (Medical) Information?

Overtesting May Lead To Unecessary Treatments

Otis Historical Archives National Museum of Health and Medicine (CC-BY)

Last year I talked about the dangers of overtesting. Once you find things, you are usually bound to follow it up.

Finding an incidental tiny spot on a CT scan of a non-smoker rarely means cancer, yet once you find the spot you have to follow it with serial scans. More scans mean more exposure to radiation.

We gave up yearly chest X-rays and EKGs — they weren’t helpful enough to justify the time and expense and led to too much testing. I have many patients who bring in screening tests from their senior center or church that show they have this problem or that problem. No symptoms, just an abnormal test they want checked out.

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Once you see any variation from normal, most people want it checked out. But it can be TMI — Too Much Information.

Let me give you a personal example: me. I’ve had kidney stones, where part of the workup included a CT scan of my urinary tract. It’s an example of good testing. The scan shows where the stone might be, how large is it, whether or not the kidney is swollen and likely to go into failure — all good things to know.

But this test done on me also picked up things that were worthless — slipped discs in my back and a partially fused spine.

Now, let me explain that when I say “worthless,” it’s because I have minimal back symptoms, back pain that I’ve had since I was in my 20s. If we just believed the CT scan, it would indicate I should have neuropathic back pain, the kind that needs heavy drugs, surgery or both.

The point is that one test picked up things that were clinically relevant as well as things that were irrelevant. (By the way, I passed the stone by myself, not a walk in the park.)

Good testing includes cholesterol and blood sugar, tests we know will pick up hidden diseases. Bad tests are the ones that are scientifically shown to be worthless.

My advice is “buyer beware.”

And while we’re on the “medicine-is-no-picnic” theme, I’d like to chime in on several deaths that occurred at UCLA’s medical center because of bacteria lurking in specially designed scopes that gastroenterologists use to look at the pancreatic ducts.

About 500,000 of these potentially life-saving procedures are done every year. The problem with the UCLA scopes — and, it turns out, with other scopes, too — is that they are extraordinarily difficult to clean.

Rogue bacteria can lurk in the corners and crevices of these gizmos, ready to strike, unless the utmost caution is used to clean them. One semi-missed minimal step in the cleaning process and it’s Bacteria 1, Patient 0.

The UCLA techs, as far as anyone can determine based on the best evidence available, did as good a job as they could with the cleaning process. But even with that, it failed.

Now, UCLA and other institutions have added extra steps to try to prevent this from happening again — extra cleaning, extra soak times, extra processing.

But just like overtesting, there is such a thing as overproceduring. That’s why, whenever your health care provider says you need a test, your response should be, “Is it really necessary or can you make a diagnosis without this procedure?”

You’ll find, dear reader, that sometimes the test is not as vital to a diagnosis as you might think. There are many expert clinicians who can make a diagnosis without invasive, potentially dangerous testing. A good doctor is worth more than a bad test.

My spin: It’s not an apple but a good clinician who perhaps can keep a needless test away. Stay well.