Ep. 16: How to Avoid Healthcare Boondoggles with Guest Dr. Kenny Lin
““I just want all the tests,” says the patient who wants to know everything is all right.
“You must have a reason to get a test,” says Dr. Lin.
“What’s wrong with getting all the tests? I just want to know everything is OK?””
American consumers receive more health care than in most other developed countries, but we are less healthy. Unnecessary testing is one of the reasons. Why does it happen and who cares?
Today we are fortunate to have Dr. Kenny Lin with us—he is an expert with a broad clinical and public health background, having attended Harvard University, the NY University School of Medicine, and Johns Hopkins School of Public Health. He is the perfect person to shed some much needed light on these questions.
Watch the Interview Here
Listen to the Audio File Here
Show Notes
The Price of Unnecessary Testing
“I just want all the tests,” says the patient who wants to know everything is all right.
“You must have a reason to get a test,” says Dr. Lin.
“What’s wrong with getting all the tests? I just want to know everything is OK?”
Dr. Lin explains that unnecessary testing comes with a cost.
Someone is paying money for the test.
Some tests have risks from the procedure itself—even obtaining a blood sample can create a hematoma. A biopsy or diagnostic procedure can create complications.
Doing “routine” labs almost always reveals some results out of the normal range—5%. These results often do not have any significance but often require more testing and create anxiety.
An imaging test can reveal something that requires even more testing—even though the finding is just something that was found incidentally and means nothing, such as a scar, benign cyst, or unusual anatomy.
A cascade of more and more tests can be the result—adding just more more risk.
How do I avoid unnecessary testing in the doctor’s office?
Ask more questions. What will be the next step if it is abnormal? What are you looking for? What is the chance you will find anything—is the test even necessary?
Talk about the pros and cons of tests with your doctor. Studies show that patients who have continuity of care with their primary care doctor receive fewer inappropriate tests and do better overall.
Learn more about the PSA prostate cancer test and how it should be used
Where is the biggest waste when it comes to medical testing?
Per Dr. Lin, the answer is unnecessary imaging tests.
Imaging tests (X-rays, CTs, MRIs) are very expensive and some require preps ahead of time, contrast administration, or even sedation. They often lead to other testing in order to investigate a finding that is unclear and sometimes to biopsies and operations. It is hard to stop this cascade of testing once it starts, regardless of risk—sometimes the testing is driven by anxious patients and sometimes by doctors who fear they will sued if they miss something.
Do I need More testing or something else?
Dr. Lin finds it helpful to ask his patients, “What are you really concerned about?”
Do you want all those labs because your father died when he was 40 and now you are 40? You just want to be sure you are OK.
Do you want the CT for your headache because your neighbor just got diagnosed with a brain tumor?
What’s going on in your life that makes you want the reassurance you hope that testing may provide? Are you stressed out?
Dr. Lin’s patient Mr. L. sought help repeatedly for hip pain, which prevented him from playing tennis. He had X-rays and an MRI. He went to physical therapy several times. The diagnosis was not clear. He was anxious and not getting any better. Then he saw a YouTube video that talked about healing yourself with exercise, stretching, meditation and similar self-help practices. He started doing these things and in a few weeks his pain went away.
Kenny and I talked about the tendency of all of us, at one time or another, to push for testing, procedures, pills and “fixes” for our problems, often delaying the much needed self-care—practices like exercise, weight loss, stress reduction, or meditation.
Conclusions
Too much medical testing is done and it causes harm.
Ask more questions of your doctor before your next labs or imaging test.
Before you push for any testing, challenge yourself to improve your self care and discuss your plan with your doctor.
Be informed. Here are some valuable references from Kenny’s past blogs:
Additional Reading & Resources
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About Dr. Kenny Lin
Kenny Lin, MD, MPH is Professor of Family Medicine at Georgetown University and Deputy Editor of American Family Physician. He is a graduate of Harvard University, New York University School of Medicine and the Johns Hopkins Bloomberg School of Public Health. Dr. Lin completed his family medicine residency at Lancaster General Hospital (PA) and a fellowship in medical editing and faculty development at Georgetown. Dr. Lin serves on the Association for Prevention Teaching and Research’s Board of Directors, the American Academy of Family Physicians Science Advisory Panel and the Secretary of Health and Human Services Advisory Committee on Breast Cancer in Young Women. His areas of expertise include cancer prevention and survivorship, screening guidelines, medical overuse, and diagnostic test interpretation. Dr. Lin writes regular commentaries for Medscape Family Medicine and shares his views on health and health policy topics on his blog, Common Sense Family Doctor.
About Donna
Dr. Donna Chacko promotes health of body, mind, and spirit through her website (serenityandhealth.com), her blog, and programs at her church. She is the author of Pilgrimage: A Doctor’s Healing Journey (Luminare Press, 2021).
Donna previously practiced medicine for forty years, first as a radiation oncologist and later, after re-training, as a family medicine doctor. What she learned taking care of immigrants and the homeless in Washington, D.C., continues to influence her programs. A central theme is that health of body, mind, and spirit is interrelated and connected to God, all as a package deal. Donna is a wife, mother, and grandmother and lives in University Park, Maryland.
Questions? Reach out to Donna Chacko.
Do you use these excuses to avoid having to take action?