Overuse of CT scans is dangerous and expensive

I read two articles yesterday that complemented each other:

In Kaiser Health News (KHN) Heavy Use Of CT Scans Raises Concerns About Patients’ Exposure To Radiation

And on KevinMD two radiologists posted The financial costs of treating CT-induced cancer

Each underscores the fact that CT scans are significantly overused in American healthcare.

Although CT scans are an essential diagnostic tool, the Food and Drug Administration reports that an estimated 30 to 50 percent of imaging tests are believed to be medically unnecessary.

Considering we spend tens of billions of dollars every year on diagnostic imaging, that’s a lot of wasted … Continue reading

Are you really allergic to penicillin?

When my son was about 10 years old he got an infected blister on his foot. I took him to the pediatrician to have the abscess drained, and then he was given a prescription for Augmentin, a fancy and expensive form of amoxicillin.

(If I knew then what I know now, of course, I would have 1) questioned whether an antibiotic was really necessary, and 2) wasn’t there a cheaper alternative to a brand name drug?)

Within 24 hours of taking the Augmentin, my son developed a terrible case of hives starting on his infected foot and eventually running up … Continue reading

Be informed – “The Patient’s Playbook”

the patient's playbookI’ve spent most of the holiday weekend happily engaged in reading through a pile of health care books.

And the one I absolutely have to recommend to everyone is The Patient’s Playbook: How to Save Your Life and the Lives of Those You Love by Leslie D. Michelson.

Michelson is not a physician, but has worked in the health management field for more than 30 years, helping individuals and companies navigate our crazy health care system.

Based on his experience, he has organized his book into three sections. Each chapter ends with a helpful “Quick Guide” of the most crucial … Continue reading

Sad but true – CYA medicine works

A few months ago I posted about CYA—Cover Your Ass—medicine being one reason why too many diagnostic tests are ordered and health care costs are high.

CYA medicine is when the doctor or doctors are pretty sure what your problem is, but they order extra scans and x-rays and blood tests anyway because “failure to diagnose” is one of the leading causes of medical malpractice suits. They aren’t going to take any chances, and who can blame them?

Related story from KevinMD: This is why doctors practice cover your ass medicine

Besides, they don’t pay your resulting medical bill, so … Continue reading

Confused by mammogram guidelines?

October is Breast Cancer Awareness Month, so I can’t let it pass without commenting on the American Cancer Society’s (ACS) recently updated screening mammogram guidelines.

Before, the ACS recommended annual mammograms starting at age 40.

Now they recommend annual mammograms for ages 45 to 54, with screening mammograms done every other year after age 55.

But, they add, women should still have the choice to start screening at age 40 and have yearly mammograms thereafter.

The confusion arises not only because the ACS is a bit wishy washy on its guidelines, but because the American College of Obstetricians and Gynecologists … Continue reading

Patients need “Choosing Wisely”

I’ve written several posts about Choosing Wisely, an initiative launched in 2012 by the American Board of Internal Medicine (ABIM) with the mission of decreasing the use of unnecessary health care.

Overuse of diagnostic tests, screening tests, surgeries and drugs is rampant in our health care culture, and it’s costing billions of dollars every year, not to mention that some patients are actually harmed by overtreatment.

It’s a noble goal, but the burden is on the consumer—the patient—to read and use Choosing Wisely’s lists of  inappropriate treatments because a recent analysis shows that physicians are not paying enough attention … Continue reading

Don’t self diagnose food allergies

When you go to the grocery store is your cart full of “free” foods, such as soy-free, dairy-free, egg-free, gluten-free, nut-free, peanut-free, etc.?

With so many of these products being heavily marketed, and poor health information being widely spread on the internet through Facebook, blogs and other social networking sites, it’s easy to make assumptions about food allergies for your and/or your children.

Common symptoms that everyone gets occasionally—nausea, diarrhea, acne, fatigue, weight gain, rashes, and sinusitis—are frequently misdiagnosed as food allergies or intolerances.

I have had many friends over the years who have told me they or one of … Continue reading

Gadolinium – Toxic residue from MRIs

A friend of mine sent me a link to this story: Left in the Brain: Potentially Toxic Residue From MRI Drugs

Most MRIs, a common diagnostic imaging test, require you to be injected with a “contrast agent” that allows the images to be more defined and therefore more useful.

It’s been known for some time that these agents can be harmful to people with impaired kidney function, so in those cases radiologists will use a more kidney-friendly agent or do without.

But now it appears that some of these contrast agents, specifically the gadolinium agents (that just sounds toxic, doesn’t … Continue reading

Cover your a** health care

“Cover-your-ass health care” or “save-my-ass medicine” are terms used to describe all the extra diagnostic tests (blood tests, CT scans, MRIs, etc.) ordered by physicians to rule out possible (but unlikely) life-threatening conditions.

Such as going to the emergency department with a headache and getting a CT scan to rule out an aneurysm or a brain tumor.

Or, as in this video example, being worked up for a heart attack when the most likely diagnosis is a simple case of heartburn. (Warning: video contains some bad language!)

The ER physician in the video is certainly … Continue reading

A routine urinalysis is unnecessary

This week the National Kidney Foundation (NKF) started a public health campaign called “Everybody Pees.”

The highlight is a short video featuring a catchy song and colorful South Park-esque kidneys peeing in all sorts of places—parks, swimming pools, on top of a car, etc.

OK, it’s cute, kind of. But here’s my problem with this video (other than the it’s a cartoon more appropriate for six-year-olds): a routine urinalysis is NOT recommended to screen for kidney disease.

But that’s what the song seems to tell us to do:

The smartest place to pee

Is at

Continue reading

Atul Gawande – Overtreament, “Overkill”

A friend of mine who is an avid reader of both The New Yorker and my blog sent me the following link: Overkill: An avalanche of unnecessary medical care is harming patients physically and financially. What can we do about it?

The author is Atul Gawande, MD, one of my favorite surgeon/writers. It’s a long article, but if you are interested in saving money on your health care (and possibly saving your health), I encourage you to take time to read it.

I have posted many times about America’s obsession with overtreatment—too many tests, too many specialists, too many … Continue reading

Better patient education for mammograms

I’ve mentioned in several posts that I think screening tests, especially mammograms, are used too widely in this country. Every woman over age 40? Every year? It’s overkill.

Even the US Preventive Services Task Force (USPSTF) only recommends a screening mammogram every other year between the ages of 50 and 75.

But most women still think the yearly mammogram is health care at its finest.

Related post: Screening mammograms—benefits vs harms

The British medical journal, Lancet, recently published a study that shows women who are better informed about the risks and benefits of screening mammograms are less likely to … Continue reading

Number Needed to Harm

I’ve written a couple of posts about the Number Needed to Treat, aka the NNT. That’s the number of people that must be treated with a drug, a procedure or a screening test to save one life.

The lower the number, the better.

Related post: Number Needed to Treat

Well, the dark twin of the NNT is the Number Needed to Harm, or the NNH. How many people can be treated before one person is harmed? In this case, the bigger the number, the better.

Aaron Carroll, MD, of The Incidental Economist blog, wrote a terrific piece in The New Continue reading

Headaches are overtreated

A study coming out of Harvard this week reveals that ordinary headaches are being overtreated, and it’s costing billions of extra dollars in health care spending.

Each year more than 12 million Americans visit their doctors complaining of headaches, which result in lost productivity and costs of upward of $31 billion annually. A new study by researchers from Beth Israel Deaconess Medical Center (BIDMC) suggests some of that cost could be offset by physicians ordering fewer tests and an increased focus on counseling about lifestyle changes.

The study looked at over 9,000 doctor visits for headaches over a 10-year … Continue reading

Screening mammograms – benefits vs. harms

The Journal of the American Medical Association (JAMA) published a short article on screening mammograms that included a spiffy infographic on the benefits vs. the harms.

Looking at the graphic I can easily see that if 10,000 50-year-old women are screened, 10 will be “saved”, but 940 will undergo an unnecessary biopsy and 57 will be overdiagnosed. (For copyright reasons I can’t reprint the graphic here, but you can view see it yourself by clicking on the above link.)

The author of the article explains:

Another possible harm of screening is overdiagnosis. This means finding something on a mammogram

Continue reading