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Needless Medical Tests Costly, Risky

May 19, 2006 -- During your next routine medical checkup you have at least a 43% chance of undergoing an unnecessary medical test, a new study shows.

It's not like you're getting something for nothing. If you're not having symptoms, and your doctor has no reason to suspect you have a problem, U.S. guidelines advise against giving you a routine urinalysis, electrocardiogram, or X-ray.

"This has more harm than benefit," says Dan Merenstein, MD, director of research in family medicine at Georgetown University. "The problem is, there are so many false-positive results from these tests. They lead to other things, like biopsies.

The tests are meant to help doctors explore specific symptoms that are troubling patients or raise suspicion of a problem. If you're a healthy person who's just getting a routine checkup, there's only a tiny chance the tests will find disease.

But Merenstein points out there's a good chance the tests will get a slightly abnormal finding. That means further costly tests -- maybe even a painful biopsy -- to show that you were, indeed, perfectly healthy to begin with.

Too Many Tests for Too Many Patients

Merenstein and colleagues analyzed CDC data on more than 4,600 preventive health exams from 1997 to 2002. All these exams were checkups on healthy people, with no specific symptoms that should have triggered special testing.

And yet:

• 37% of checkups included a urinalysis.
• 9% of checkups included an electrocardiogram.
• 8% of checkups included an X-ray.
• 43% of checkups included at least one of these three tests.

It's an important study, says Robert Schwartz, MD, chairman of the department of family medicine and community health at the University of Miami Miller School of Medicine.

"There are many things we do in primary care that are unnecessary -- unnecessary because there is no proof that by doing these exams we get data that makes a difference to a patient's health care," Schwartz tells WebMD.

Unfortunately, Schwartz says, his experience bears out Merenstein's findings.

"It happens all the time," he says. "The patient has no symptoms and doesn't smoke, but he gets a routine chest X-ray. If there is a small shadow, doctors are obligated to look further. That X-ray becomes a CT scan. That may show a small little nodule. The next thing you know, the patient ends up with a cardiothoracic surgeon who wants a needle biopsy, or even an open biopsy. In a lot of these cases, he comes up with nothing, a benign nodule or something."

Aside from the costs in time and the potential for unnecessary suffering, these procedures add up to big money. Merenstein's modest estimate of the cost of just these three simple tests is $47 million to $194 million a year. And that doesn't include the cost of follow-up tests.