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Original Research: Shawna V. Hudson, Pamela Ohman-Strickland, Jeanne M. Ferrante, Grace Lu-Yao, A. John Orzano, and Benjamin F. Crabtree Prostate-Specific Antigen Testing among the Elderly in Community-Based Family Medicine Practices J Am Board Fam Med 2009; 22: 257-265 [Abstract] [Full text] [PDF]

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Screening Outside Guildelines: Expensive Futility

Peter G Teichman   (28 May 2009)

Screening Outside Guildelines: Expensive Futility 28 May 2009
Peter G Teichman, Family Medicine Doctor FV Hospital, Vietnam Send response to journal: Re: Screening Outside Guildelines: Expensive Futility p.teichman{at}fvhospital.com Peter G Teichman	Doctor-directed clinical activites that are unsupported by medical evidence and ignore credible guidelines can be summed up in two words: thoughtless practice. Some of the harms that follow thoughtess screening practices include: • Lost opportunities: doctor-patient interactions that stray into inappropriate screening testing risk missing opportunities to focus on more useful testing or to bypass screeing in favor of directly providing effective preventive services. • High rate of false positive results: screening tests reveal incidental “abnormal” results that lead to patient anxiety, false diagnostic labeling, and more testing that compounds risk and increases costs. • Impracticality: the discovery of unmodifiable disease or disease in the presence of treatment limting co-moribidities is unlikely to alter the extent or quality of a patient’s life, and because of treatment side effects and risks, may decrease both. • Diversion of resources: no matter how distant the consequences of inappropirate testing may seem, health care spending is bound by the rules of all zero sum enterprises—dedicating resources to wayward testing subtracts from our ability to deliver beneficial services. • Decreased trust: when doctors recommend medical services that are not clinically indicated, informed patients become less confident in the knowledge and integrity of individual doctors and the medical profession in general. As lawmakers and the public seek advice on how to effectively provide health care in the face of incresing needs and diminishing resources, can Family Medicine doctors genuinely expect to be listened to if we cannot overcome our patients and our own fondness for expensive futility?