Health News Review

A thoughtful perspective piece in JAMA Internal Medicine‘s “Less is More” series is entitled, “A Dual-Energy X-ray Absorptiometry Scan:  Need to Know vs. Nice to Know.”

The DXA scan is a test looking for signs of osteoporosis.

The piece is written by a woman physician who had turned 50 and was now facing a recommendation from her own doctor to “catch up on testing” she had not had.  Key excerpt:

“I did not want to question my physician. The tests felt like evidence of her care, concern, and thoroughness; she wanted to make sure that she did not miss anything that might help me. I wanted to follow her recommendations. I wanted a guide who knew where I needed to go and what I would need along the way.

Unsurprisingly, my ECG scan result was normal. The DXA scan result placed me in the category of low bone mineral density, for which calcium and vitamin D and weight-bearing exercise are all recommended—as they would have been without the test result. While my insurance covered the cost of the DXA scan, I am not sure who benefited, beyond the manufacturers of the test.

When a physician suggests a test, it is easy for a patient to believe that it is important and necessary. It is easy to believe that the test result will tell us the right next step or will assure us that all is well. But the harder reality is that there is so much we just cannot know, that tests cannot make clear. The harder role for the physician is to help the patient understand that there will be uncertainty and that perhaps the best we can do is work on developing habits of healthy living. The harder explanation is about the limits and risks of tests.”

It’s worth noting that the author, Lorna Lynn, MD,  works for the American Board of Internal Medicine, the folks who promote the Choosing Wisely campaign.

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Comments

Bruce Parker posted on February 11, 2014 at 9:32 am

I count myself fortunate that the counters have not implemented a way to include my practice of emergency medicine in metric driven medical care. As a hit-and-run doctor, I have little responsibility for long term care. [I do watch for opportunities to make patients' and other doctors' lives easier by ordering tests they will find useful or inevitable, to save a visit cycle.] Until we routinely include the number needed to treat/test [NNT] for benefit AND the number neaded to treat/test [NNH] – including the subsequent effects of false positive and false negative tests – we are performing rumor based medical care. Few are willing to include the placebo and nocebo effects in discussion. Most want a simple answer, where there are often no simple answers. Still, this puzzle beats shuffleboard. Bruce Parker MD FACEP