“Iwill not have a mammogram,” says Heather, who works at an assisted-living facility. “I pay attention to my body, do self-exams, and I think I would know if something was wrong. If I suspected a health issue, I would go to my doctor and then consult with him about having a mammogram.” She is not fearful of taking medical tests but feels there are so many unnecessary ones.
In an informal survey I conducted with about 75 people, the tests most people avoided, or would not go through again, included colonoscopies, MRI (magnetic resonance imaging) scans, and mammograms. A few said they not only disliked these tests but felt their physicians did not need them in order to improve their health. Some said the cost was too much even with insurance, and others in this group said they did not want to spend the time getting these tests.
Heather has a primary care doctor and wonders if people who go through the battery of basic medical tests—mammograms, blood tests, colonoscopies, etc., are really healthier because of the tests. She remembers that several years ago, she had injured her back at work and visited a neurologist who ordered a few tests, including an EMG—electromyography, a diagnostic procedure that assesses the health of muscles and the nerve cells that control motor neurons. The EMG results can reveal nerve dysfunction, muscle dysfunction, or problems with nerve-to-muscle signal function. After speaking with her doctor, she ended up having her gall bladder removed.
After a few months, she still had back pain. She saw her doctor again and told him about the pain. Her doctor threw his hands in the air and told her, “You are definitely a conundrum! The test did not show anything wrong!”
Heather says, “I wonder if people are healthier if they go through all these tests?” She remembers her doctor, whom she saw for decades growing up into adulthood, and says that he followed her symptoms. It was a trusting relationship. Her new doctor seems good, but she is getting to know him and her trust level with him is just beginning. She adds, “The jury is still out on him.”
Heather thinks that by listening to her body, she knows when something is wrong or when she needs medical help. She said she doesn’t avoid tests because of costs or because she is afraid of the results. She said she would deal with the results as they were discovered, but she feels she knows her own body better than a doctor who doesn’t even touch her during office examinations.
Most healthcare professionals encourage medical tests and screenings as fundamental to health care. The results of tests are part of preventive health care to help patients understand their risk for developing chronic conditions before symptoms are present, enabling them and their doctors to take action to potentially prevent disease. Many healthcare screenings can identify risk factors that can lead to cardiovascular disease, stroke, peripheral artery disease, osteoporosis, and other serious illnesses. Medical tests and screenings can offer a patient peace of mind and early detection, and they are usually non-invasive, affordable, and easy.
The Centers for Disease Control and Prevention (CDC) says that with testing, the trouble is that few people are getting the right tests. Overall, Americans get only half the needed preventive care—including screenings. Many people are screened too frequently, at the wrong age, or with tests that are not very accurate.
Medical tests are defensive medicine. Every symptom can mean different things, and all doctors are aware that patients might sue them if a diagnosis is missed. For example, a cough might be a sign of a typical cold, but it might also be a sign of the first stage of metastatic lung cancer. Even if your doctor is 99% sure that you do not have cancer, he or she might be motivated by good practice, or the fact you might sue if you find out you have cancer five or ten years down the road. He or she might order a chest computerized tomography (CT) scan, even for a light cough.
So, what does a patient do? Talk honestly with your healthcare professionals. Let them know why you do not want to take the test—fear of the test, costs, the time they would take, etc. Be honest about your body and family history, and ask your doctor to be honest with you. You, as a patient, have a right to choose whether to take tests or not—but be aware of the possible health risks down the road that could have been prevented with early detection.