Introduction

Reviews

Avoiding Unnecessary "Routine Tests"

Timothy B. McCall, M.D.

“Routine” tests are often unnecessary. A routine test may simply be a test the doctor orders more out of habit than because there’s any good reason for doing it. Batteries of routine tests are often little more than fishing expeditions.

Studies suggest that routine chemistry panels, which include such tests as blood sugar, sodium, potassium and calcium are of little use, although when the doctor suspects a particular condition, some of the individual components are worth checking. Routine blood counts have proven to be almost worthless. Routine EKGs are probably only worthwhile for elderly patients or for those with known heart disease, although obtaining a single “baseline” EKG sometime in mid-life may be worthwhile. Another commonly unnecessary routine test is the chest X-ray.

An article in the Annals of Internal Medicine reviewed 15 published studies that evaluated the value of routine chest X-rays done before operations and on admission to the hospital. The authors concluded the X-rays almost never helped doctors care for these patients. In fact, misleading results are much more likely than helpful ones. The authors recommended the practice of obtaining routine chest X-rays be stopped, unless the patient has symptoms of chest disease or is going to have surgery of the chest. In the absence of symptoms, even decades of cigarette smoking was insufficient reason for an X-ray.

The potential impact of eliminating unnecessary routine chest X-rays is enormous: an estimated 30 million routine chest X-rays are taken in U.S. hospitals per year, at a cost to consumers of 1.5 billion dollars. Thirty million X-rays also mean a great deal of unnecessary radiation exposure.

I've experienced this first hand. On Christmas eve of my internship year, while on duty in the Emergency Room, I became acutely ill with an intestinal infection. I lost so much fluid so quickly that the nurse hooked me up to an IV and poured in three liters of saline solution. At that point, they sat me up in a wheelchair and rolled me out to the telephone to call my family. After sitting up for one minute, I felt so lightheaded I nearly passed out. I knew I’d have to be admitted to the hospital at least overnight.

On my way to the ward, they rolled my gurney into the X-ray suite for a routine chest X-ray. No one had asked me what I thought of the idea. Even in my compromised condition, I knew the X-ray was inappropriate. I was a healthy non-smoker with an intestinal infection and not so much as a cough. I politely refused the test and a day and a half later was well enough to go home.

Next: Deciding Whether You Need to Have a Test

Return to Examining Your Doctor